title: Extranodal marginal zone B-cell lymphoma of the lung in Sjögren's syndrome patients: reappraisal of clinical, radiological, and pathology findings.
abstract: BACKGROUND
  Primary Sjögren's syndrome (pSs) is an autoimmune rheumatic disease that may express in a small number of patients a spectrum of lymphoproliferative diseases. The aim of this study was to describe clinical, imaging and pathology features of the extranodal marginal zone B-cell lymphoma (MZCL) of the lung of mucosa-associated lymphoid tissue (MALT) type in patients with pSs.
  
  
  METHODS
  All patients (N=10) with biopsy proven MZCL of the lung of MALT type diagnosed in a tertiary teaching hospital during the last 7 years were studied.
  
  
  RESULTS
  Seven patients had pSs. Almost all patients presented an indolent clinical course, contrasting strongly with the spectacular radiological findings in both chest roentgenograms and computed tomography. Pathology infiltration patterns observed were either nodular, peribronchial-perivascular, alveolar, or interstitial. Immunohistochemical study in all cases showed B cell phenotypes. Immunoglobulin light chain restriction was demonstrated in all patients. Monoclonal IgM(kappa) was evident in 5/7, IgM(lambda) in 1/7 and IgG (kappa) in 1/7 of patients.
  
  
  CONCLUSIONS
  Lung MZCL associated with pSs are characterized by an important dissociation between clinical expression and radiological pattern. Clinical presentation and imaging features are not specific. Therefore, histologic documentation is mandatory to ensure diagnosis. Various chemotherapeutic agents in combination with rituximab lead to partial or complete remission in the majority of patients.
authors.affiliation: 2nd Pulmonary Department, Attikon University Hospital, 1 Rimini Street, 12462 Haidari, Athens, Greece. papiris@otenet.gr
authors.forename: Spyros A
authors.initials: SA
authors.lastname: Papiris
authors.forename: Ioannis
authors.initials: I
authors.lastname: Kalomenidis
authors.forename: Katerina
authors.initials: K
authors.lastname: Malagari
authors.forename: George E
authors.initials: GE
authors.lastname: Kapotsis
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Harhalakis
authors.forename: Effrosyni D
authors.initials: ED
authors.lastname: Manali
authors.forename: Dimitra
authors.initials: D
authors.lastname: Rontogianni
authors.forename: Charis
authors.initials: C
authors.lastname: Roussos
authors.forename: Haralampos M
authors.initials: HM
authors.lastname: Moutsopoulos
mesh_terms: D001402:B-Lymphocytes / Q000473:pathology; D015415:Biomarkers / Q000032:analysis; D015496:CD4-Positive T-Lymphocytes / Q000473:pathology; D005260:Female; D006801:Humans; D007150:Immunohistochemistry / Q000379:methods; D007633:Keratins / Q000032:analysis; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology; D016393:Lymphoma, B-Cell / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D018442:Lymphoma, B-Cell, Marginal Zone / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D012859:Sjogren's Syndrome / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology; D014057:Tomography, X-Ray Computed
chemical_list: D015415:Biomarkers; D007633:Keratins