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Pulmonary infiltration with eosinophilia complicated with mucosa-associated lymphoid tissue lymphoma: A case report

View Article: PubMed Central - PubMed

ABSTRACT

Tissue eosinophilia is rarely observed in cases of non-Hodgkin's lymphoma of B cell origin. The present study describes a rare case of mucosa-associated lymphoid tissue (MALT) lymphoma, which was initially misdiagnosed as eosinophilic pneumonia. The initial diagnosis was formed based on the results of chest radiography, peripheral eosinophilia tests and bronchoalveolar lavage, and the clinical course of the patient. Following administration of methylprednisolone (40 mg/day) for 4 days and oral administration of prednisolone (30 mg/day), the clinical course rapidly improved and the eosinophil count immediately decreased a to normal level. However, abnormal shadows observed on computed tomography (CT) scans of the chest did not diminish. At 6 months after the initiation of treatment, CT-guided percutaneous lung biopsy was performed, and a final diagnosis of primary pulmonary mucosa-associated lymphoid tissue lymphoma was made based on immunohistochemical examination. Primary lung MALT lymphoma remains a rare entity, with an indolent course and a reasonably favorable prognosis, whose diagnosis may be challenging.

No MeSH data available.


(A) Diffuse, severe lymphoid cell infiltration with a few plasma cells in the interstitium and alveolar walls (hematoxylin and eosin staining; magnification, ×100). (B) Lymphoid cells were evenly admixed with B lymphocytes, which were immunoreactive for cluster of differentiation 20 (immunostaining with polymer/multimer 3,3′-diaminobenzidine detection system on paraffin embedded sections; magnification, ×200).
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f2-ol-0-0-4841: (A) Diffuse, severe lymphoid cell infiltration with a few plasma cells in the interstitium and alveolar walls (hematoxylin and eosin staining; magnification, ×100). (B) Lymphoid cells were evenly admixed with B lymphocytes, which were immunoreactive for cluster of differentiation 20 (immunostaining with polymer/multimer 3,3′-diaminobenzidine detection system on paraffin embedded sections; magnification, ×200).

Mentions: On day 4 of hospitalization, bronchoscopy with a transbronchial lung biopsy (TBLB) was performed from the left lingular lobe and the right middle lobe spur. In addition, BAL was performed on the right middle lobe. The percentage of eosinophils observed in the fluid obtained from BAL was 64%. Based on these observations, the patient was diagnosed with eosinophilic pneumonia. Corticosteroids (40 mg/day methylprednisolone) were administered for 3 days, followed by oral administration of prednisolone (30 mg/day), which resulted in immediate improvement, with the eosinophil count rapidly decreasing from 44.1% to a normal level within 3 days. The patient was discharged and instructed to gradually reduce the dose of prednisolone to 20 mg. However, 6 months after the initiation of treatment, the abnormal shadow observed on CT scans of the chest had not diminished (Fig. 1D-F). CT-guided needle biopsy of the lung was performed. Tissue samples were fixed in 10% neutral formaldehyde solution (Sigma-Aldrich China, Inc., Shanghai, China), dehydrated, embedded in paraffin (Leica Biosystems, Shanghai, China), and conventionally stained with hematoxylin and eosin. Microscopic examination (BX41; Olympus Corporation, Tokyo, Japan) of the specimen revealed an intense lymphoid infiltrate, which primarily consisted of B cells (Fig. 2A). Deparaffinized sections of patient tissue samples were washed with phosphate-buffered saline (PBS) three times for 5 min each. In order to block the endogenous peroxidase activity, the sections were incubated in PBS that contained 3% H2O2 for 10 min, and then immersed in 10% sheep serum for 30 min, prior to be incubated overnight with specific antibodies against cluster of differentiation (CD)3 (clone PS1; mouse anti-human monoclonal antibody; dilution, 1:100; PA0553; Novo castra; Leica Biosystems), CD5 (clone 4C7; mouse anti-human monoclonal antibody; dilution, 1:100; M3641; Dako, Glostrup, Denmark), CD20 (clone L26; mouse anti-human monoclonal antibody; dilution, 1:500; M0755; Dako) and CD79a (clone JCB117; mouse anti-human monoclonal antibody; dilution, 1:150; M7050; Dako). The sections were washed and stained according to the manufacturer's protocol. Immunohistochemical analysis demonstrated that the lesion was positive for B cell markers, including cluster of differentiation (CD)20, CD79a and B cell lymphoma 2, and negative for T cell markers, including CD5 and CD3 (Fig. 2B). These findings were consistent with a diagnosis of MALT lymphoma. Thus, the patient was referred to the Department of Hematology of Drum Tower Hospital, where the patient was treated with 6 cycles of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone). The patient was followed up 30 months, and continues to be stable at present.


Pulmonary infiltration with eosinophilia complicated with mucosa-associated lymphoid tissue lymphoma: A case report
(A) Diffuse, severe lymphoid cell infiltration with a few plasma cells in the interstitium and alveolar walls (hematoxylin and eosin staining; magnification, ×100). (B) Lymphoid cells were evenly admixed with B lymphocytes, which were immunoreactive for cluster of differentiation 20 (immunostaining with polymer/multimer 3,3′-diaminobenzidine detection system on paraffin embedded sections; magnification, ×200).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998093&req=5

f2-ol-0-0-4841: (A) Diffuse, severe lymphoid cell infiltration with a few plasma cells in the interstitium and alveolar walls (hematoxylin and eosin staining; magnification, ×100). (B) Lymphoid cells were evenly admixed with B lymphocytes, which were immunoreactive for cluster of differentiation 20 (immunostaining with polymer/multimer 3,3′-diaminobenzidine detection system on paraffin embedded sections; magnification, ×200).
Mentions: On day 4 of hospitalization, bronchoscopy with a transbronchial lung biopsy (TBLB) was performed from the left lingular lobe and the right middle lobe spur. In addition, BAL was performed on the right middle lobe. The percentage of eosinophils observed in the fluid obtained from BAL was 64%. Based on these observations, the patient was diagnosed with eosinophilic pneumonia. Corticosteroids (40 mg/day methylprednisolone) were administered for 3 days, followed by oral administration of prednisolone (30 mg/day), which resulted in immediate improvement, with the eosinophil count rapidly decreasing from 44.1% to a normal level within 3 days. The patient was discharged and instructed to gradually reduce the dose of prednisolone to 20 mg. However, 6 months after the initiation of treatment, the abnormal shadow observed on CT scans of the chest had not diminished (Fig. 1D-F). CT-guided needle biopsy of the lung was performed. Tissue samples were fixed in 10% neutral formaldehyde solution (Sigma-Aldrich China, Inc., Shanghai, China), dehydrated, embedded in paraffin (Leica Biosystems, Shanghai, China), and conventionally stained with hematoxylin and eosin. Microscopic examination (BX41; Olympus Corporation, Tokyo, Japan) of the specimen revealed an intense lymphoid infiltrate, which primarily consisted of B cells (Fig. 2A). Deparaffinized sections of patient tissue samples were washed with phosphate-buffered saline (PBS) three times for 5 min each. In order to block the endogenous peroxidase activity, the sections were incubated in PBS that contained 3% H2O2 for 10 min, and then immersed in 10% sheep serum for 30 min, prior to be incubated overnight with specific antibodies against cluster of differentiation (CD)3 (clone PS1; mouse anti-human monoclonal antibody; dilution, 1:100; PA0553; Novo castra; Leica Biosystems), CD5 (clone 4C7; mouse anti-human monoclonal antibody; dilution, 1:100; M3641; Dako, Glostrup, Denmark), CD20 (clone L26; mouse anti-human monoclonal antibody; dilution, 1:500; M0755; Dako) and CD79a (clone JCB117; mouse anti-human monoclonal antibody; dilution, 1:150; M7050; Dako). The sections were washed and stained according to the manufacturer's protocol. Immunohistochemical analysis demonstrated that the lesion was positive for B cell markers, including cluster of differentiation (CD)20, CD79a and B cell lymphoma 2, and negative for T cell markers, including CD5 and CD3 (Fig. 2B). These findings were consistent with a diagnosis of MALT lymphoma. Thus, the patient was referred to the Department of Hematology of Drum Tower Hospital, where the patient was treated with 6 cycles of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone). The patient was followed up 30 months, and continues to be stable at present.

View Article: PubMed Central - PubMed

ABSTRACT

Tissue eosinophilia is rarely observed in cases of non-Hodgkin's lymphoma of B cell origin. The present study describes a rare case of mucosa-associated lymphoid tissue (MALT) lymphoma, which was initially misdiagnosed as eosinophilic pneumonia. The initial diagnosis was formed based on the results of chest radiography, peripheral eosinophilia tests and bronchoalveolar lavage, and the clinical course of the patient. Following administration of methylprednisolone (40 mg/day) for 4 days and oral administration of prednisolone (30 mg/day), the clinical course rapidly improved and the eosinophil count immediately decreased a to normal level. However, abnormal shadows observed on computed tomography (CT) scans of the chest did not diminish. At 6 months after the initiation of treatment, CT-guided percutaneous lung biopsy was performed, and a final diagnosis of primary pulmonary mucosa-associated lymphoid tissue lymphoma was made based on immunohistochemical examination. Primary lung MALT lymphoma remains a rare entity, with an indolent course and a reasonably favorable prognosis, whose diagnosis may be challenging.

No MeSH data available.