Clinical Characteristics,Diagnosis,Treatment And Prognosis Of Pulmonary Mucosa-associated Lymphoid Tissue Lymphoma

Objective: Pulmonary mucosa-associated lymphoid tissue(MALT)lymphoma is a type of extranodal lymphoma,which is rarely seen in clinical practice.At present,the research on the disease at home and abroad is mostly carried out in the form of case reports,and the incidence of the disease has increased in recent years.This study mainly conducted statistical analysis on the clinical features,diagnosis,treatment methods and prognosis of pulmonary MALT lymphoma,so as to summarize the disease and help clinicians better understand the disease and avoid missed diagnosis and misdiagnosis.Methods: In this study,we searched the case reports of pulmonary MALT lymphoma in Wanfang database,China National Knowledge Infrastructure,Weipu database and Pub Med,and select a total of 64 cases that meet the requirements.These reports must record the clinical data such as sex,age,smoking history,clinical manifestation,imaging manifestation,laboratory examination,pathological results,treatment and prognosis,etc.Combined with 2 cases diagnosed by pathological biopsy at the First Affiliated Hospital of Wannan Medical College from October 2018 to October 2020,these 2 cases were respectively from the Department of Respiratory and Critical Care Medicine and the Department of Infectious Diseases,a total of 66 cases,application SPSS 24.0 software to analyze the collected data,P < 0.05 was statistically significant.Results: 1.Among the 66 patients with pulmonary MALT lymphoma,32 were males(48.5%)and 34 were females(51.5%).There was no significant difference in incidence between sexes.The average age of onset was 59.47±13.45 years old,ranging from 20 to91 years old,and patients aged from 40 to 60 years old were most common(65.2%).2.The etiology is still unclear.Possible causes include smoking(27 cases),viral infection(1 case of hepatitis C,1 case of AIDS),autoimmune diseases(1 case of Sjogren’s syndrome,2 cases of rheumatoid arthritis,1 case of multiple sclerosis),chronic cardiopulmonary diseases(6 cases of hypertension,3 cases of COPD,2 cases of pulmonary tuberculosis)and psoriasis(1 case).3.The clinical manifestation was not specific.42 patients showed respiratory symptoms(63.6%),including cough(38 cases,57.6%),expectoration(26 cases,39.4%),dyspnea(15 cases,22.7%),chest tightness and asthma(8 cases,12.1%),chest pain(5 cases,7.6%),hemoptysis(7 cases,10.6%),etc.,of which 14 cases had lymphoma-like B symptoms(21.2%).The other 24 cases had no obvious symptoms(36.4%)and were found during physical examination.The main positive signs included lung rale(20 cases,30.3%)and decreased respiratory sound(14 cases,21.2%).4.Chest CT findings were diverse.The main manifestations were pulmonary involvement,including single lesions(35 cases,53.0%)and ≥2 lesions(31 cases,47.0%)in the lung.Most of the cases were single lobe involvement(42 cases,63.6%),and there was no significant difference in left and right lobe involvement(left lung: right lung = 1:1.04).Lymph node involvement(10 cases,15.2%)and pleural effusion(6 cases,9.0%)were observed in some patients.In addition,extrapulmonary involvement was rare(4 cases,6.1%).5.Histopathological examination must be performed for definite diagnosis,in which the main positive indexes of immunohistochemical staining were CD20(61 cases,93.4%),CD79a(55 cases,83.3%)and Bcl-2(48 cases,72.2%).The main indicators of negative staining were CD3(46 cases,69.7%),CD5(52 cases,78.8%),CD10(37 cases,56.1%),Cyclin D1(31 cases,47.0%).Ki-67 < 10%(46 cases,69.7%).6.At present,there is no clear standard for treatment,and the existing methods include surgical resection,chemotherapy,radiotherapy and observation.In this study,simple lobectomy / segmental lobectomy(16 cases,24.2%),surgical resection combined with postoperative radiotherapy and chemotherapy(4 cases,6.1%),chemotherapy(29 cases,44%),radiotherapy(2 cases,3%),observation(15 cases,22.7%),and whether surgery(P=0.637)is not a prognostic risk factor for overall survival(OS)of pulmonary MALT lymphoma.7.The results of univariate analysis showed that age(P=0.001),LDH(P=0.043)and number of pulmonary lesions(P=0.041)were the prognostic risk factors for OS of pulmonary MALT lymphoma,while the results of multivariate analysis only showed that age(P=0.042)was an independent prognostic risk factor for OS.Conclusion: 1.The most common age of onset of pulmonary MALT lymphoma was between 40 and 60 years old,and there was no significant difference between males and females.2.The etiology of pulmonary MALT lymphoma is temporarily unclear,and the clinical manifestations and chest CT findings are diverse.A clear diagnosis must rely on pathology,and immunohistochemical examination is specific.3.Currently,there is still no unified standard for the treatment of pulmonary MALT lymphoma.Surgical resection is the first choice for patients with localized lung tumors;when bilateral pulmonary lesions,extrapulmonary involvement,or disease progression,chemotherapy is the only option.Some patients will also spontaneously regress after observation.4.The 5-year OS rate of pulmonary MALT lymphoma is 87%,and age(>60 years)is an independent prognostic risk factor affecting OS,indicating that the disease is inert and has a good prognosis.