Marginal-zone B-cell lymphoma, extranodal-malt-type: Report of three cases

A high proportion of extranodal lymphoid infiltrates are diffuse small lymphocytic proliferations [1, 2] and therefore pose a particularly challenging diagnostic problem [1-4]. Their benign or malignant nature cannot be determined using clinical and radiologic criteria. The application of traditional morphologic criteria (i.e., cytologic maturity and polymorphism favor benignancy, while cytologic atypia and monomorphism favor malignancy) [5, 6], has probably improved diagnostic accuracy. However, these criteria generally have not been helpful in evaluating the large number of lymphoid infiltrates composed of monomorphic collections of small cytologically-mature appearing lymphoid cells [1-4] and, therefore, have not always accurately predicted clinical behavior. Extranodal lymphoid proliferations are also of considerable biologic interest since their pathogenesis and natural history have not been fully elucidated. Localized non-Hodgkin's lymphoma, extranodal-MALT-type. was diagnosed in our Department in three cases: Two arose in the orbit and the third one in the tonsil. The tumors had a typical histologic appearance. The microscopical features and immunohistochemical profile are discussed.

N H Lymphomas; Orbital lymphoid lesions; Waldeyer's ring lymphoid lesions; CT

[1] Burke J. S.: "T he diagnosis of extranodal lymphomas and lymphoid hyperplasias ('pseudolymphoma') other than those involving the lung". In: Jaffe E. S. (ed) "Surgical Pathology of Lymph Nodes And Related Organs". Philadelphia, Orell S., P. A., Saunders, 1985. 298.

[2] Knowles D. M.:'The extranodal lymphoid infiltrate: A diagnostic dilemma". Semin. Diagn. Pathol., 1985, 2, 147. Marteli G., Pilotti S., L epera P., Piromalli D., Bono A., Di Pietro S., Galante E. "Fine needle aspiration cytology in superficial lymph nodes: an analysis of 2 66 cases". Eur. J. Surg. Oneal., 1989, 15, 13.

[3] Knowles D. M.. Jakobiec F. A.: "Cell marker analysis of extranodal lymphoid infiltrates: To what extent does the determination of mono- or polyclonality resolve the diagnosis dilemma of malignant lymphoma u pseudolymphoma in an extranodal site?". Semin. Diagn. Pathol., 1985, 2, 163.

[4] Burke J. S.: "Histologic criteria for distinguishing between benign and malignant extranodal lymphoid infiltrates". Semin. Diagn. Pathol., 1985, 2, 154.

[5] Saltzstein S. L.: "Pulmonary malignant lymphomas and pseudolymphomas. Classification, therapy and prognosis". Cancer, 1981, 16, 928. (1963 Kiel classification). Springer, Berlin.

[6] Saltzstein S. L.: "Extranodal malignant lymphomas and pseudolymphomas". Pathol. Annu., 1969, 4, 159.

[7] Freeman C., Berg J. W., Cutler S. J.: "Occurrence and prognosis of extranodal lymphomas". Cancer, 1972, 29, 252.

[8] Winther B., Innes D. J.: "The human adenoid. A morphologic study". Arch. Otolaryngol. Head Neck Surg., 1994, 120, 144.

[9] Graeme-Cook F., Bhan A. K., Harris N. L.: "Immunohistochemical characterization of intraepithelial and sub-epithelial mononuclear cells of the upper airways". Am. J. Pathol., 1993, 143, 1416.

[10] Knowles D. M., Jacobiec F. A.: "Malignant lymphomas and lymphoid hyperplasias that occur in the ocular adnexa (orbit, conjunctiva and eyelids)". In: "Neoplastic Hematopathology". Knowles D. M. ed. Baltimore, Williams & Wilkins, 1992, 1009.

[11] Ellis J. H.,B anks P. M.,C ampbell R. J.,L iesegang T. J.: "Lymphoid tumors of the ocular adnexa". Opthamology, 1985, 92, 1311.

[12] Knowles D. M., Jakobiec F. A., McNally L., Burke J. S.: "Lymphoid hyperplasia and malignant lymphoma occurring in the ocular adnexa (orbit, conjunctiva, and eyelids): a prospective multiparametric analysis of 108 cases during 1977 to 1987". Hum. Pathol., 1990, 21, 959.

[13] Jakobiec F. A., Knowles D. M.: "An overview of ocular lymphoid tumors". Trans. Am. Ophthamol. Soc., 1990, 87, 420.

[14] Nicolo M., Truini M., Sertoli M., Taubenberger J. K., Zingririan M.: "Follicular large-cell lymphoma of the orbit: a clinicopathologic, immunohistochemical and molecular genetic description of one case". Graefes Arch. Clin. Exp. Ophthalmol., 1999 July, 237(7), 606.

[15] Bolek T. W., Moyses H. M., Marcus R. B. et al.: "Radiotherapy in the management of orbital lymphoma". J. Radiat. Oncol. Biol. Phys., 1999 Apr., 1, 44(1), 31.

[16] Nagaki Y., Hayasaka S., Kitagawa K., Maeda Y.: "Orbital lymphoma of mucosa-associated lymphoid tissue in a patient with rheumatoid arthritis". Jpn. J. Ophthalmol., 1998 May-June, 42(3), 223.

[17] Galieni P., Polito E., Leccisotti A. et al.: "Localised orbital lymphoma". Haematologica, 1997 July-Aug., 82(4), 436.

[18] Gustafsson A.: "Non-Hodgkin's lymphomas (NHL)". Acta Oneal., 1996, 35 Suppl. 7, 102.

[19] Trieblemont C., Bastion Y., Berger F. et al.: "Mucosa-associated lymphoid tissue gastrointestinal and nongastrointestinal lymphoma behavior: analysis of 108 patients". J. Clin. Oneal., 1997 Apr., 15(4), 1624.

[20] Bailey E. M., F erry J. A., Harris N. I. et al.: "Marginal zone lymphoma (low grade B-cell lymphoma of mucosa-associated lymphoid tissue type) of skin and subcutaneous tissue: a study of 15 patients". Am. J. Surg. Pathol., 1996 Aug., 20(8), 1011.

[21] White W. L, Ferry J. A., Harris N. L., Grove A. S. Jr.: "Ocular adnexal lymphoma. A clinicopathologic study with identification of lymphomas of mucosa-associated lymphoid tissue type". Ophthalmology , 1995 Dec., 102(12), 1994.

[22] Graeme-Cook F., Bhan A. K., Harris N. L.: "Immunohistochemical characterisation of intraepithelial and subepithelial mononuclear cells of the upper airways". Am. J. Path., 1993, 143, 1416.

[23] Wright D. H.: "Lymphomas of Waldeyer's ring. Commentary". Histopathology, 1994, 24, 97.

[24] Menarguez J., Mollejo M., Carrion R. et al.: "Waldeyer ring lymphomas. A clinicopathologic study of 79 cases". Histopathology, 1994, 24, 13.

[25] Ye Y. L.,Z hou M. H.,L u X. Y.,D ai Y. R.,W u W. X.: "Nasopharyngeal and nasal malignant lymphoma: a clinicopathological study of 54 cases". Histopathology, 1992, 20, 511.

[26] Paulsen J., Lenert K.: "Low-grade B-cell lymphoma of mucosaassociated lymphoid tissue in Waldeyer's ring". Histopathology, 1994, 24, 1.