Chest
Volume 138, Issue 3, September 2010, Pages 730-733
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Selected Reports
Two Cases With Pulmonary Mucosa-Associated Lymphoid Tissue Lymphoma Successfully Treated With Clarithromycin

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A 70-year-old woman with a history of sinobronchial syndrome was admitted to the hospital because of a cough, sputum, and abnormal chest shadow. She was diagnosed with pulmonary mucosa-associated lymphoid tissue lymphoma (p-MALToma) based on results of a pathologic examination and the gene rearrangements in the Ig heavy chain on Southern blot hybridization. Although p-MALToma did not regress with conventional therapy, it was reduced after long-term treatment with clarithromycin (CAM) (200 mg/d). A 57-year-old woman with a history of Sjögren syndrome and lymphocytic interstitial pneumonia had a mass lesion in the left lower lung field. CT image-guided biopsy established a diagnosis of p-MALToma. The p-MALToma regressed with long-term treatment with CAM (200 mg/d), whereas Helicobacter pylori (HP) eradication therapy was not effective in concurrent atrophic gastritis with HP. It is suggested that CAM, a macrolide antibiotic, may be effective in some patients with p-MALToma.

Section snippets

Case 1

A 70-year-old woman with a history of chronic sinusitis was admitted to our hospital after developing cough and sputum. A medical examination 12 years before admission showed a small consolidative shadow in the left lung (Fig 1A). An enlarged consolidative shadow and a transbronchial biopsy revealed bronchiectasis 4 years earlier. She was diagnosed with sinobronchial syndrome (SBS). However, the consolidative shadow gradually increased in size, and a chest roentgenogram on admission

Discussion

A definitive diagnosis of p-MALToma is obtained after a detailed histologic examination of biopsy specimens is obtained during transbronchial biopsy, radiologically guided transthoracic core-needle biopsy, or surgical lung biopsy. A diagnosis of p-MALToma based on these findings has a favorable prognosis because p-MALToma is an indolent disease with the potential for spontaneous regression and also has a favorable response to surgery, chemotherapy, or radiotherapy. Consequently, Troch et al5

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