Aggeliki Baliaka, Styliani Papaemmanouil, Angeliki Cheva, Ioannis Matzarakis, Ioannis Dimitriadis, Leonidas Sakkas
Background: BALT lymphoma represents a low-grade B-cell lymphoma, derived from cells of the marginal zone of the bronchus-associated lymphoid tissue (WHO 2004). It accounts for less than 0.5% of all lung neoplasms, but constitutes 70-90% of all lung lymphomas. The majority of patients are in their fifth-seventh decade of life. Pulmonary lesions are frequently discovered incidentally on a routine chest radiograph as solitary nodule or less common as multiple unilateral or bilateral nodules or diffuse lobar infiltrates.
Objective: A 15-year retrospective analysis of histologically diagnosed BALT lymphoma in our department and the presentation of the difficulties in its diagnosis-identification.
Methods: Eight cases with BALT lymphoma from 1999-2014 were diagnosed in our department. The majority of the patients were males (7/8), aged 45-70 years (median age: 57.5 years). The diagnostic material in five cases included biopsy samples and in the rest three cases surgical specimens from partial lobectomy.
Results: In 7/8 cases, after correlation between immunohistochemical and clinicoradiological findings, the diagnosis of BALT lymphoma was easily confirmed. In one case the biopsy sample was not adequate to confirm a diagnosis of lymphoproliferative neoplasm, which presence proved in subsequent time.
Conclusions: BALT lymphoma usually have an indolent course and the outcome has been generally favorable, with a 5-year survival rate of >80% and a median survival time >10 years. Surgical resection is preferred for localized lesions. Chemotherapy should be considered in patients with bilateral lesions or with extrapulmonary disease. BALT lymphoma identification presents diagnostic problems for pathologists due to its heterogeneous appearance and similarity to nonneoplastic conditions, such as nodular lymphoid hyperplasia and lymphocytic interstitial pneumonia. The correlation between clinical-imaging-pathology findings is very important for the final diagnosis.
