A 71-year-old woman with chronic cough and bilateral cysts with peripheral solid components was diagnosed with cystic pulmonary MALT lymphoma following a right upper lobe wedge resection.
Case Report (n=1)
This case highlights a rare cystic manifestation of pulmonary MALT lymphoma, emphasizing the need for histologic evaluation of cystic lung lesions with nodular or hypermetabolic progression.
Abstract Introduction Pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma is a rare extranodal marginal zone B-cell neoplasm, accounting for 1% of primary pulmonary malignancies. Diagnosis is often challenging, as it requires tissue biopsy, and radiologic findings are typically nonspecific and variable. Although consolidative or nodular forms predominate, cystic presentations are exceptionally uncommon. We present an unusual case of cystic pulmonary MALT lymphoma emphasizing the need for early tissue evaluation in atypical cystic lung disease. Case Presentation A 71-year-old woman with a history of treated tuberculosis presented in 2022 with a chronic productive cough for years. She denied dyspnea or systemic symptoms. She immigrated from El Salvador 40 years ago, was a lifelong nonsmoker, and had no occupational exposures. Her father had lung cancer. Chest radiograph was initially unremarkable. In 2024, she was hospitalized for Streptococcus anginosus bacteremia. Chest CT demonstrated multiple bilateral cysts with peripheral solid components and paratracheal/subcarinal lymphadenopathy. Autoimmune testing (ANA, ACE, Sjögren’s antibodies) and HIV were negative, but serum kappa free light chain (62.68 mg/L) and kappa/lambda ratio (3.23) were elevated. PET-CT revealed scattered hypermetabolic solid nodules, mostly associated with pneumatoceles. Due to the progression of the solid components, a right upper lobe wedge resection was performed. Histopathology confirmed extranodal marginal zone B-cell lymphoma (MALT type) with plasmacytic differentiation. Discussion Pulmonary MALT lymphoma is an indolent B-cell malignancy with heterogeneous imaging findings that may mimic infectious, autoimmune, or interstitial processes. Cystic changes likely result from peribronchiolar lymphoid infiltration causing localized air trapping and parenchymal remodeling rather than necrosis or cavitation. It affects both genders equally, is not associated with smoking, typically presents in the seventh decade of life, and clinically has nonspecific symptoms. In this patient, mural nodularity and metabolic activity within cysts were critical diagnostic clues prompting biopsy. Radiologic evolution from cystic to nodular patterns should raise suspicion for lymphoproliferative disease. Accurate diagnosis depends on tissue confirmation, as radiologic features alone are insufficient. Pulmonary MALT lymphoma is amenable to surgical, systemic, or targeted therapy when recognized early and has a favorable prognosis. This case highlights a rare and diagnostically challenging disease, often requiring tissue biopsy due to its nonspecific clinical and radiological features. Conclusion This case highlights a rare cystic manifestation of pulmonary MALT lymphoma, illustrating that indolent lymphoid infiltration may produce cystic remodeling masquerading as benign disease. Recognition of nodular or hypermetabolic progression within cystic lesions should prompt histologic evaluation to prevent diagnostic delay and guide appropriate therapy. This abstract is funded by: None
Desai et al. (Fri,) conducted a case report in Cystic Pulmonary MALT Lymphoma (n=1). Right upper lobe wedge resection was evaluated on Diagnosis of extranodal marginal zone B-cell lymphoma (MALT type). A 71-year-old woman with chronic cough and bilateral cysts with peripheral solid components was diagnosed with cystic pulmonary MALT lymphoma following a right upper lobe wedge resection.