PMC5491818_01
a, b: Chest CT scan showing ground-glass opacities and small nodules in all lung fields. c, d: Chest CT scan taken after three courses of R-CHOP therapy showing improvements.
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A 37-year-old female with no history of thromboembolic complications visited our hospital for an evaluation of abnormal chest computed tomography (CT) findings in a routine physical examination (Fig. 1a and b). She received rituximab (375 mg/m2, day 1) plus cyclophosphamide (750 mg/m2, day 2), doxorubicin (50 mg/m2, day 2), vincristine (1.4 mg/m2, day 2), and prednisolone (50 mg/m2, days 2 to 6) (R-CHOP) chemotherapy, and her chest CT findings (Fig. 1c and d) and sIL2R level (525 U/mL) markedly improved after 1 course of chemotherapy.
a: Pulmonary MALT lymphoma showing reactive B-cell follicles surrounded by neoplastic marginal zone cells that infiltrate the bronchiolar epithelium (Hematoxylin and Eosin staining, 50x). b: Occlusive thrombi in small pulmonary vessels (100x).
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A microscopic examination revealed lymphoepithelial lesions characterized by diffuse infiltration of the lung parenchyma by small lymphocytes, monocytoid cells, and plasma cells (Fig. 2a). A transbronchial lung biopsy showed thromboses in small pulmonary vessels (Fig. 2b).
a, b: MRI showing acute infarction in the right anterior lobe.
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Brain magnetic resonance imaging (MRI) revealed acute infarction in the right anterior cerebral artery territory (Fig. 3).
Chest radiography showing bilateral alveolar infiltrates.
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Chest radiography showed bilateral infiltration in the lungs (Fig. 4).
Antiphospholipid Ab levels before and after the treatment.
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Laboratory tests on admission showed that aCL and beta2GP1 were markedly elevated (>120 AU/mL and 48.8 U/mL, respectively) (Fig. 5).
Abdominal CT scan showing lymphadenopathies with the progression of lymphoma.
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However, CT showed enlarged abdominal lymph nodes (Fig. 6) with an elevated sIL2R level (860 U/mL), which indicated the deterioration of MALT lymphoma after chemotherapy.