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Primary pulmonary lymphoma arising from mucosa- or bronchus-associated lymphoid tissue (MALT or BALT) is a rare disease.1,2 We report a 30 year old man with low grade B cell BALT lymphoma who presented with a bulky mass in the lung and was treated successfully with cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP) combined chemotherapy.
The patient was admitted with a dry cough, shortness of breath, back pain, and progressive infiltrates on chest radiographs. He had no history of risks for BALT lymphoma.1,3,4 No rash or lymphadenopathy or organomegaly was detected. A CT scan of the chest showed a right mid lung bulky mass with a diameter of 10.9 × 10.6 cm and infiltrations in both lung fields (fig 1). A transbronchial biopsy specimen was compatible with low grade (B cell lymphoplasmocytoid type) lymphoma. Immunohistochemical examination showed a monoclonal membrane surface κ light chain positive. The patient underwent combined chemotherapy (CHOP) which was repeated every 3 weeks. He tolerated the treatment without difficulty, his symptoms improved, and CT scans after completion of six courses of treatment showed a marked reduction in the lesions in both lung fields (fig 2).
BALT lymphoma shows an indolent course and remains localised for a prolonged period of time, with systemic dissemination occurring late in the clinical course.2 Recommended treatment options include complete surgical resection, radiotherapy, or chemotherapy. The role of surgery in the management of primary lymphoma of the lung is twofold: (1) to obtain diagnostic tissue and (2) to obtain a therapeutic resection. In our case we used combined chemotherapy because surgical intervention is of limited use in patients with a large non-resectable lesion or bilateral lung disease.2,5
We conclude that, in patients with a large or bilateral pulmonary BALT lymphoma, transbronchial or transthoracic biopsy and mediastinoscopy are useful diagnostic procedures for obtaining a definitive diagnosis5 and treatment with combined chemotherapy should be considered.
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