Diagnostic challenges and management strategies of pulmonary mucosa-associated lymphoid tissue lymphoma: a case report and literature review
Abstract
BACKGROUND: Pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma is a rare extranodal B-cell lymphoma, representing the most common primary pulmonary lymphoma (< 0.5% of all lung malignancies). Diagnosis is difficult because of its nonspecific clinical and radiological characteristics, which often resemble infections, inflammatory diseases, or other malignancies. Typical imaging findings include nodules, consolidations, or, less frequently, interstitial patterns such as ground-glass opacities. A conclusive diagnosis requires histological examination, augmented by immunohistochemistry and molecular investigations, to confirm clonality. Conventional biopsies may yield inconclusive outcomes due to small sample size and delicate cytologic atypia.
CASE PRESENTATION: A 36-year-old non-smoking Asian female with no history of pulmonary tuberculosis, malignancies, or autoimmune disorders was incidentally found to have patchy opacities in the left lower lobe on routine chest radiography in January 2024. She remained asymptomatic over the 18-month disease progression period, lacking respiratory or systemic symptoms, whereas follow-up imaging indicated progression to bilateral, multifocal flocculent opacities. Initial investigations, including transbronchial forceps biopsy and bronchoalveolar lavage fluid analysis through next-generation sequencing, reported only non-specific chronic inflammation and no pathogens. Empirical treatment with moxifloxacin (400 mg daily for 14 days),…
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