Patologìâ (Sep 2019)
Primary pulmonary lymphoma from bronchus-associated lymphoid tissue (clinical observation)
Abstract
Purpose. To describe the clinical case of rare indolent extranodal non-Hodgkin’s lymphoma, which originates from bronchus-associated lymphoid tissue, and to analyze the main current trends in the diagnosis and treatment of this pathology. Using bibliosemantic and analytical methods of research in modern scientific literature, we analyzed the main historical data and clinical-radiological and immunomorphological criteria for the diagnosis of casuistically rare neoplasm – the primary pulmonary non-Hodgkin's lymphoma – the indolent extranodal B-cell lymphoma of the marginal zone, arising from the bronchus-associated lymphoid tissue (BALT). The prevalence of BALT-lymphoma is less than 0.5 % of all pulmonary malignant tumors and less than 1 % of all non-Hodgkin’s lymphomas. Nowadays, diagnostic approaches and standard systemic treatment of this disease are still widely discussed. The recommendations of the retrospective international study of primary extranodal lymphoma of lungs from the marginal zone conducted by the international extranodal lymphoma study group (IELSG) are presented and the main recommendations of the NCCN for the diagnosis and treatment of mucosa-associated lymphoma (2019) are analyzed. Treatment options for BALT-lymphomas vary in the range from antibiotic therapy and clinical observation to surgical resection or combination with chemotherapy and radiotherapy, but optimal therapy for the disease needs further study. It is noted that precise morphological definition and immunohistochemical phenotyping allow choosing an adequate protocol for chemo-therapeutic treatment (immunochemotherapy). The main options for radical surgical, chemo-therapeutic and radiological stages of BALT-lymphoma treatment and indications for their combined use within the framework of the multidisciplinary approach to treatment with lymphomas are discussed and their effectiveness is determined. The actual 4-year clinical observation of 48 year old patient with BALT-lymphoma is presented and the main radiological diagnostic criteria and difficulties of morphological diagnostics and immunohistochemical phenotyping are discussed. The above clinical observation is aimed at information of a wide range of practicing doctors – therapists, pulmonologists, phthisiologists, thoracic surgeons, oncologists, radiologists. Conclusions. BALT-lymphoma is a rare form of extranodal non-Hodgkin’s lymphoma, that does not have clear clinical guidelines and specific radiological signs and requires well-balanced histological diagnostics and immunohistochemical verification, which, in combination with computed tomography (PET-CT) methods, determines the stage of the disease and, respectively, tactics for the management of patients.
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