Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue type arising in the pleura with pleural fibrous plaques in a lathe worker

Our plain-English summary of Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue type arising in the pleura with pleural fibrous plaques in a lathe worker, by S. Nakatsuka, T. Nagano, H. Kimura, et al (Annals of Diagnostic Pathology, 2012).

The study

• Authors: S. Nakatsuka, T. Nagano, H. Kimura, S. Hanada, H. Inoue, T. Iwata
• Journal: Annals of Diagnostic Pathology
• Published: 2012;16(3):224-9
• Type of article: Case report
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Our patient was an 86-year-old man who had worked as a lathe operator for 40 years. He had no history of tuberculosis, pyothorax, or autoimmune disease. He had not been exposed to asbestos. He was asymptomatic, but an imaging study showed gradually increasing pleural plaques. A biopsy specimen of a pleural lesion showed sclerosis of the pleura and diffuse infiltration of small- to medium-sized B lymphocytes. Polymerase chain reaction-based analysis detected monoclonal rearrangement of immunoglobulin heavy-chain genes. Histologic diagnosis was extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue type (MALT lymphoma). The lymphoma was negative for Epstein-Barr virus. We report a rare case of a metal worker with MALT lymphoma arising in the pleura with pleural fibrous plaques. It is speculated that MALT lymphoma might develop in the background of pneumoconiosis. Inflammatory and/or immunologic reactions to metal particles might contribute to the oncogenesis of this tumor.

Copyright © 2012 Elsevier Inc. All rights reserved.

In plain English

This case report from Japan described one 86-year-old man who had worked as a lathe operator for 40 years and, the article states, had not been exposed to asbestos. CT scans had shown pleural plaques on both sides. Over 13 months the right plaque grew slightly and showed high uptake of a glucose tracer on PET-CT, although he had no symptoms. A biopsy taken during thoracoscopic surgery showed scarring of the pleura with a diffuse infiltrate of small- to medium-sized B lymphocytes. A gene test of the tissue found a single (monoclonal) cell population. The diagnosis was extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue type (MALT lymphoma) arising in the pleura. Epstein-Barr virus was not found, no asbestos bodies were seen, and asbestosis was not shown on tissue examination. The authors compiled 7 previously reported cases of pleural MALT lymphoma, and 1 of those had a history of asbestos exposure. The authors concluded that a possible association between the lymphoma and pneumoconiosis from inhaled metal particles was suggested. They noted that the metals he had handled were unclear.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report, with a table of previously reported cases of primary pleural MALT lymphoma
• Who was studied: one 86-year-old man, a former lathe operator, seen at Kansai Rosai Hospital, Amagasaki, Japan; dates of care not given
• Exposure: 40 years of work as a lathe operator, metal types unknown; the article states he had not been exposed to asbestos; he smoked 10 cigarettes a day from age 20
• Main results:
  • CT 2 years before admission showed bilateral pleural plaques. After 13 months the right pleural plaque was slightly larger and showed high FDG accumulation on PET-CT. The patient had no symptoms.
  • The biopsy showed localized sclerosis of tissue beneath the mesothelium, with diffuse infiltration of small- to medium-sized lymphocytes
  • The tumor cells were positive for the B-cell markers CD20 and CD79a, and negative for CD3, CD5, CD10, CD45RO and cyclin D1
  • PCR testing of the tumor tissue detected monoclonal rearrangement of immunoglobulin heavy-chain genes. Southern blot testing of cells in the drained pleural fluid showed no clonal bands.
  • The diagnosis was extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue type (MALT lymphoma)
  • In situ hybridization did not detect Epstein-Barr virus RNA in the tumor
  • In this patient no asbestos body was observed, and asbestosis was not proved on tissue examination
  • Of the 7 previously reported patients with primary pleural MALT lymphoma that the authors compiled, 1 had a history of asbestos exposure (listed with asbestosis), and none had a history of metalworking
• The authors' conclusion: The authors concluded that MALT lymphoma arose in the pleura with pleural fibrous plaques. They speculated that it develops against a background of chronic pleural inflammation. They wrote that a possible association with pneumoconiosis due to inhaled metal particles was suggested, but that the mechanism remains unclear.
• Limitations the authors state:
  • The types of metal the patient had handled were unclear
  • The authors note that no study has suggested an association between lymphoma and pneumoconiosis
  • Human herpesvirus-8 was not tested
  • Serum soluble interleukin-2 receptor was not measured

Topics

The National Library of Medicine indexes this study under subjects our site covers: Pleural plaques and thickening.

Medical terms in this study, explained in our Lexicon: Pleura, Pleural Plaques, Empyema, Biopsy, Monoclonal, Pneumoconiosis, Oncogenesis.

Related studies

• IgG4-producing marginal zone B-cell lymphoma — Y. Sato, K. Takata, et al. (2008)
• Carboxyterminal propeptide of type I procollagen in ELF: elevation in asbestosis, but not in pleural plaque disease — L. Lammi, L. Ryhänen, et al. (1999)
• 'Black Spots' and hyaline pleural plaques on the parietal pleura of 150 urban necropsy cases — K. Mitchev, P. Dumortier, et al. (2002)
• Asbestos-related lesions of the pleura: parietal plaques compared to diffuse thickening studied with chest roentgenography, computed tomography, lung function, and gas exchange — G. Hillerdal, P. Malmberg, et al. (1990)
• Clinicopathologic characteristics of malignant mesotheliomas arising in patients with a history of radiation for Hodgkin and non-Hodgkin lymphoma — L.R. Chirieac, J.A. Barletta, et al. (2013)
• Pleural plaques in asbestos-exposed workers: reproducibility of a new high-resolution CT visual semiquantitative measurement method — G.S. Meirelles, J.I. Kavakama, et al. (2006)

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