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Sinonasal Mucosa–Associated Lymphoid Tissue Lymphoma

Sinonasal Mucosa–Associated Lymphoid Tissue Lymphoma Mucosa-associated lymphoid tissue (MALT) is a specialized form of lymphoid tissue that may be acquired at sites in response to chronic inflammation. Most low-grade, B-cell, non-Hodgkin lymphomas that occur at extranodal sites derive from acquired MALT. Confusing and overlapping terms have been used to describe these lymphomas, but immunohistochemical advances now allow more precise subtyping. Our review of the literature yielded only 2 previous reports of sinonasal MALT-derived lymphoma, and we report an additional case in a patient with a history of chronic sinusitis. Current developmental theories of MALT-derived lymphomas are discussed. In addition, we review the clinical, histologic, and immunophenotypic features of MALT-derived lymphomas.Mucosa-associated lymphoid tissue (MALT) is a specialized form of lymphoid tissue characterized by chronic inflammatory infiltrate. MALT is generally described as a unique pattern of lymphoid nodules containing follicular centers next to a mucosal surface. The histologic and dynamic nature of MALT have been well characterized by Isaacson and Norton.MALT may perform a protective function at vulnerable sites of permeable mucosa in direct contact with the external environment. Acquired MALT can arise in the setting of chronic inflammation or autoimmune disease.Up to 40% of non-Hodgkin lymphomas (NHL) arise in extralymphatic tissue or organs and are classified as extranodal.Most extranodal, low-grade, B-cell NHLs are derived from MALT and may arise in sites without native MALT. For example, the most common site of NHL in the gastrointestinal tract is the stomach, a site that normally has no MALT.Acquired MALT may thus be important in the development of MALT-derived lymphomas.In 1983, Isaacson and Wrightobserved that some low-grade, B-cell lymphomas of the gastrointestinal tract exhibited features of MALT. Since their characterization as a distinct type of lymphoma, low-grade, B-cell (MALT-derived) lymphomas have been found in the gastrointestinal tract, lung, breast, kidney, prostate, liver, gallbladder, and uterine cervix.In addition, MALT-derived lymphomas have been described in several head and neck sites, including the thyroid, salivary gland, trachea, larynx, and orbit.We report a case of MALT-derived lymphoma of the sinonasal tract and review the English-language biomedical literature. To our knowledge, this is the third reported case of sinonasal MALT-derived lymphoma.REPORT OF A CASEINITIAL MANAGEMENTA 49-year-old man with a 20-year history of chronic sinusitis was seen in our department. The patient had been evaluated for allergy and had received nasal corticosteroids and several courses of antibiotics without experiencing relief. Physical examination results showed bilateral nasal congestion and diffuse polypoid change in the nasal mucosa. Purulent drainage from the middle meatus was also noted bilaterally. After aggressive medical management failed, the patient was offered functional endoscopic sinus surgery. Preoperative computed tomographic scans of the sinuses revealed soft tissue opacification of the paranasal sinuses, consistent with pansinusitis (Figure 1).Figure 1.Preoperative computed tomographic scan shows soft tissue opacification of paranasal sinuses consistent with pansinusitis.Standard functional endoscopic sinus surgery revealed thickened mucosa of the middle meatus and tenacious secretions in the maxillary sinuses. The patient's clinical presentation and operative findings were consistent with routine chronic sinusitis.PATHOLOGIC FINDINGSThe specimen consisted of tan soft tissue resembling thickened mucosa and of bone fragments. Hematoxylin-eosin–stained sections showed chronic sinusitis characterized by mixed-cell, chronic inflammatory infiltrate with reactive follicles. In some areas, a population of monotonous, small lymphocytes (Figure 2) was evident with an occasional lymphoepithelial lesion (Figure 3). Immunohistochemical analysis showed that these small lymphocytes stained for CD20 and aberrantly coexpressed CD43. T-cell markers were absent. These findings confirmed low-grade, B-cell, MALT-derived lymphoma of the sinonasal tract.Figure 2.Pathologic specimen shows population of monotonous, small B-cell lymphocytes of mucosa-associated lymphoid tissue–derived type (medium magnification, hematoxylin-eosin, ×100).Figure 3.Pathologic specimen also shows centrally located, characteristic lymphoepithelial lesion (high magnification, hematoxylin-eosin, ×400).FURTHER MANAGEMENTThe patient's condition did not improve after surgery, and he was referred to oncology. Oncologic evaluation revealed disseminated disease infiltrating into the bone marrow. Computed tomographic scans of the chest and abdomen did not reveal further signs. The oncology consultant recommended reserving chemotherapy for worsening of signs and symptoms.COMMENTNon-Hodgkin lymphomas of the sinonasal tract are uncommon neoplasms that make up 1.5% of all NHLs in the United States.Sinonasal lymphomas are usually accompanied by nasal obstruction, unilateral and progressive epistaxis, hyposmia, and nasal swelling or mass.Most sinonasal lymphomas described in Western studies are of B-cell origin, but studies from Asia and Peru document predominantly peripheral T-cell lymphomas.Recently, in the United States, Abbondanzo and Wenigfound that sinonasal lymphomas are slightly more common in male patients. In that series, nasal lymphomas were most frequently of T-cell origin and sinus lymphomas were predominantly B-cell neoplasms. In addition, the Kiel Lymph Node Registryreported a large series of sinonasal lymphomas and found no MALT-derived lymphomas.MALT-derived lymphomas were initially described in 1983 as a unique clinicopathologic entity associated with gastrointestinal lesions.These observations were expanded to include similar tumors involving other mucosal tissue. MALT-derived lymphoma is microscopically characterized by proliferation of follicle marginal zone cells (monocytoid B cells), often with surrounding reactive germinal centers, follicular colonization, Dutcher bodies, plasmacytic differentiation, and lymphoepithelial lesions.Lymphoepithelial lesions are composed of centrocytelike cells that have invaded the mucosal epithelium. When present, lymphoepithelial lesions are a distinct feature of MALT-derived lymphomas.In the past, these lesions were often described as pseudolymphomas or lymphoid hyperplasia because of their association with histologic features that suggested a benign or reactive process, including reactive follicles, preserved glandular architecture, and mixed inflammatory infiltrate. By using immunohistochemical techniques, we can now classify many cases as MALT-derived lymphoma.The immunohistochemical markers of MALT-derived lymphoma cells confirm B-cell lineage and usually include surface IgM+, cytosolic Ig+, CD19+, CD20+, and CD22+. The tumor cells are characteristically CD5−.Review of prior literature concerning sinonasal MALT lymphomas is difficult because various classification systems have been used. Extranodal lymphomas have no widely accepted classification system, a situation that results in overlapping and confusing terminology. For example, the term monocytoid B-cell lymphomahas been used to describe a low-grade, nodal or extranodal B-cell lymphoma manifesting clinical, histologic, and immunophenotypic features similar to MALT-derived lymphomas. Because of these similarities, some authorshave used the name marginal zone, B-cell lymphomato describe both lesions. As previously stated, recent immunohistochemical advances have allowed more precise subtyping. This inconsistent terminology could have limited our review of the literature, which revealed only 2 other cases of sinonasal MALT-derived lymphoma. In 1994, Isaacson and Nortonbriefly referred without details to a multifocal, B-cell, MALT-derived lymphoma involving both the nose and the larynx. Bhattacharyya et aldescribed a case involving the anterior wall of the right maxillary sinus in a 56-year-old woman. The patient also had gastric involvement and received chemotherapy and gastric external beam radiotherapy. According to the authors, the patient remained free of disease 2 years after treatment. In addition, one other possible case of sinonasal MALT-derived lymphoma was noted by Abbondanzo and Wenig.However, their specimen was not immunophenotyped, because no fresh or frozen tissue was available.Our case of primary sinonasal MALT-derived lymphoma was associated with symptoms and clinical examination results consistent with chronic sinusitis. Our case has features corresponding to current developmental theories of MALT-derived lymphomas. Most cases of MALT-derived lymphoma occur in sites devoid of native lymphoid tissue. The lymphoma arises from MALT accumulation due to chronic inflammation or autoimmune disease.MALT-derived lymphomas of the salivary glands always arise from myoepithelial sialadenitis, often in the setting of Sjögren disease.Similarly, gastric MALT-derived lymphomas are associated with chronic Helicobacter pyloriinfection.Like gastric mucosa, the sinonasal tract normally contains sparse lymphoid tissue. However, well-developed lymphoid follicles may be seen in chronic sinusitis. Our case may represent MALT accumulation due to chronic inflammation that then transformed into MALT-derived lymphoma. This case raises an etiologic question: Did chronic sinusitis cause the development of acquired MALT and the subsequent lymphoma, or did the lymphoma obstruct the osteomeatal complexes and thus lead to chronic sinusitis?MALT lymphomas are probably antigen driven, and regression has been observed when the antigen stimulus is withdrawn. For example, primary gastric MALT lymphomas can completely regress after eradication of H pyloriinfection.Clinical features of these lymphomas have been found to differ from nodal low-grade, B-cell lymphomas. MALT-derived lymphomas generally occur in adults, slightly more often in women.These indolent lesions appear to remain localized for long periods and often respond to local therapy, including excision and radiotherapy.Multifocal or disseminated lymphomas are treated with chemotherapy, with or without radiotherapy.Overall prognosis is better than that of nodal tumors of similar histologic grade.When disseminated, MALT-derived lymphomas involve other mucosal sites and appear to be incurable.Transformation to large-cell lymphomas can occur. In a recent study,patients with advanced-stage MALT lymphomas were treated with combination chemotherapy and had a median failure-free survival of only 2.3 years. This result suggests that such lymphomas carry a poor prognosis once disseminated.CONCLUSIONSFirst, primary MALT-derived lymphomas of the sinonasal tract are low-grade, B-cell NHL. Second, we believe that this is only the third case of sinonasal MALT-derived lymphoma reported, but that these tumors may be diagnosed with increasing frequency in the future because of technologic advances. Third, a theoretical "2-way" causative relation between chronic sinusitis and MALT-derived lymphoma is introduced. Fourth, treatment effectiveness remains to be determined.PGIsaacsonAJNortonExtranodal Lymphomas.Edinburgh, NY: Churchill Livingstone; 1994.WHWilderSGHarnerPMBanksLymphoma of the nose and paranasal sinuses.Arch Otolaryngol.1983;109:310-312.PGIsaacsonJSpencerMalignant lymphoma of mucosa-associated lymphoid tissue.Histopathology.1987;11:445-462.PIsaacsonDHWrightExtranodal malignant lymphoma arising from mucosa-associated lymphoid tissue.Cancer.1984;53:2515-2524.PIsaacsonDHWrightMalignant lymphoma of mucosa-associated lymphoid tissue: a distinctive type of B-cell lymphoma.Cancer.1983;52:1410-1416.TCDissACWotherspoonPSpeightLPanPGIsaacsonB-cell monoclonality, Epstein Barr virus, and t (14;18) in myoepithelial sialadenitis and low-grade B-cell MALT lymphoma of the parotid gland.Am J Surg Pathol.1995;19:531-536.H-PHornyAFerlitoACarboneLaryngeal lymphoma derived from mucosa-associated lymphoid tissue.Ann Otol Rhinol Laryngol.1996;105:577-583.HFFrierson JrSEMillsDJInnes JrNon-Hodgkin's lymphomas of the sinonasal region: histologic subtypes and their clinicopathologic features.Am J Clin Pathol.1984;81:721-727.EHannaJWanamakerDAdelsteinRTubbsPLavertuExtranodal lymphomas of the head and neck: a 20-year experience.Arch Otolaryngol Head Neck Surg.1997;123:1318-1323.ECampoACardesaLAlosNon-Hodgkin's lymphomas of nasal cavity and paranasal sinuses: an immunohistochemical study.Am J Clin Pathol.1991;96:184-190.RLiangDToddTKChanNasal lymphoma: a retrospective analysis of 60 cases.Cancer.1990;66:2205-2209.JADuncavageBHCampbellGAHansonDiagnosis of malignant lymphomas of the nasal cavity, paranasal sinuses, and nasopharynx.Laryngoscope.1983;93:1276-1280.SLAbbondanzoBMWenigNon-Hodgkin's lymphoma of the sinonasal tract: a clinicopathologic and immunophenotypic study of 120 cases.Cancer.1995;75:1281-1291.CFellbaumM-LHansmannKLennertMalignant lymphomas of the nasal cavity and paranasal sinuses.Virchows Arch Pathol Anat Histopathol.1989;414:399-405.EMBaileyJAFerryNLHarrisMCMihm JrJOJacobsonLMDuncanMarginal 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;20:1011-1023.RIFisherSDahlbergBNNathwaniPMBanksTPMillerTMGroganA clinical analysis of two indolent lymphoma entities: mantle cell lymphoma and marginal zone lymphoma (including the mucosa-associated lymphoid tissue and monocytoid B-cell subcategories): a Southwest Oncology Group study.Blood.1995;85:1075-1082.NBhattacharyyaRAFrankenthalerHIGomolinMEKadinAMLauretanoClinical and pathologic characterization of mucosa-associated lymphoid tissue lymphoma of the head and neck.Ann Otol Rhinol Laryngol.1998;107(9, pt 1):801-806.EBayerdörfferANeubauerBRudolphRegression of primary gastric lymphoma of mucosa-associated lymphoid tissue after cure of Helicobacter pyloriinfection: MALT Lymphoma Study Group.Lancet.1995;345:1591-1594.PGQuintanaSBKapadiaDWBahlerJTJohnsonSHSwerdlowSalivary gland lymphoid infiltrates associated with lymphoepithelial lesions: a clinicopathologic, immunophenotypic, and genotypic study.Hum Pathol.1997;28:850-861.Accepted for publication December 18, 1998.Presented at the annual meeting of the Bay Area Resident Research Symposium, Oakland, Calif, June 5, 1998.The Medical Editing Department, Kaiser Foundation Research Institute, Oakland, provided editorial assistance.Corresponding author: Raul M. Cruz, MD, Department of Head and Neck Surgery, Kaiser Permanente Medical Center, 280 W MacArthur Blvd, Oakland, CA 94611-5693 (e-mail: raul.cruz@ncal.kaiperm.org). http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA Otolaryngology - Head & Neck Surgery American Medical Association

Sinonasal Mucosa–Associated Lymphoid Tissue Lymphoma

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American Medical Association
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Copyright 1999 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.
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2168-6181
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2168-619X
DOI
10.1001/archotol.125.5.585
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Abstract

Mucosa-associated lymphoid tissue (MALT) is a specialized form of lymphoid tissue that may be acquired at sites in response to chronic inflammation. Most low-grade, B-cell, non-Hodgkin lymphomas that occur at extranodal sites derive from acquired MALT. Confusing and overlapping terms have been used to describe these lymphomas, but immunohistochemical advances now allow more precise subtyping. Our review of the literature yielded only 2 previous reports of sinonasal MALT-derived lymphoma, and we report an additional case in a patient with a history of chronic sinusitis. Current developmental theories of MALT-derived lymphomas are discussed. In addition, we review the clinical, histologic, and immunophenotypic features of MALT-derived lymphomas.Mucosa-associated lymphoid tissue (MALT) is a specialized form of lymphoid tissue characterized by chronic inflammatory infiltrate. MALT is generally described as a unique pattern of lymphoid nodules containing follicular centers next to a mucosal surface. The histologic and dynamic nature of MALT have been well characterized by Isaacson and Norton.MALT may perform a protective function at vulnerable sites of permeable mucosa in direct contact with the external environment. Acquired MALT can arise in the setting of chronic inflammation or autoimmune disease.Up to 40% of non-Hodgkin lymphomas (NHL) arise in extralymphatic tissue or organs and are classified as extranodal.Most extranodal, low-grade, B-cell NHLs are derived from MALT and may arise in sites without native MALT. For example, the most common site of NHL in the gastrointestinal tract is the stomach, a site that normally has no MALT.Acquired MALT may thus be important in the development of MALT-derived lymphomas.In 1983, Isaacson and Wrightobserved that some low-grade, B-cell lymphomas of the gastrointestinal tract exhibited features of MALT. Since their characterization as a distinct type of lymphoma, low-grade, B-cell (MALT-derived) lymphomas have been found in the gastrointestinal tract, lung, breast, kidney, prostate, liver, gallbladder, and uterine cervix.In addition, MALT-derived lymphomas have been described in several head and neck sites, including the thyroid, salivary gland, trachea, larynx, and orbit.We report a case of MALT-derived lymphoma of the sinonasal tract and review the English-language biomedical literature. To our knowledge, this is the third reported case of sinonasal MALT-derived lymphoma.REPORT OF A CASEINITIAL MANAGEMENTA 49-year-old man with a 20-year history of chronic sinusitis was seen in our department. The patient had been evaluated for allergy and had received nasal corticosteroids and several courses of antibiotics without experiencing relief. Physical examination results showed bilateral nasal congestion and diffuse polypoid change in the nasal mucosa. Purulent drainage from the middle meatus was also noted bilaterally. After aggressive medical management failed, the patient was offered functional endoscopic sinus surgery. Preoperative computed tomographic scans of the sinuses revealed soft tissue opacification of the paranasal sinuses, consistent with pansinusitis (Figure 1).Figure 1.Preoperative computed tomographic scan shows soft tissue opacification of paranasal sinuses consistent with pansinusitis.Standard functional endoscopic sinus surgery revealed thickened mucosa of the middle meatus and tenacious secretions in the maxillary sinuses. The patient's clinical presentation and operative findings were consistent with routine chronic sinusitis.PATHOLOGIC FINDINGSThe specimen consisted of tan soft tissue resembling thickened mucosa and of bone fragments. Hematoxylin-eosin–stained sections showed chronic sinusitis characterized by mixed-cell, chronic inflammatory infiltrate with reactive follicles. In some areas, a population of monotonous, small lymphocytes (Figure 2) was evident with an occasional lymphoepithelial lesion (Figure 3). Immunohistochemical analysis showed that these small lymphocytes stained for CD20 and aberrantly coexpressed CD43. T-cell markers were absent. These findings confirmed low-grade, B-cell, MALT-derived lymphoma of the sinonasal tract.Figure 2.Pathologic specimen shows population of monotonous, small B-cell lymphocytes of mucosa-associated lymphoid tissue–derived type (medium magnification, hematoxylin-eosin, ×100).Figure 3.Pathologic specimen also shows centrally located, characteristic lymphoepithelial lesion (high magnification, hematoxylin-eosin, ×400).FURTHER MANAGEMENTThe patient's condition did not improve after surgery, and he was referred to oncology. Oncologic evaluation revealed disseminated disease infiltrating into the bone marrow. Computed tomographic scans of the chest and abdomen did not reveal further signs. The oncology consultant recommended reserving chemotherapy for worsening of signs and symptoms.COMMENTNon-Hodgkin lymphomas of the sinonasal tract are uncommon neoplasms that make up 1.5% of all NHLs in the United States.Sinonasal lymphomas are usually accompanied by nasal obstruction, unilateral and progressive epistaxis, hyposmia, and nasal swelling or mass.Most sinonasal lymphomas described in Western studies are of B-cell origin, but studies from Asia and Peru document predominantly peripheral T-cell lymphomas.Recently, in the United States, Abbondanzo and Wenigfound that sinonasal lymphomas are slightly more common in male patients. In that series, nasal lymphomas were most frequently of T-cell origin and sinus lymphomas were predominantly B-cell neoplasms. In addition, the Kiel Lymph Node Registryreported a large series of sinonasal lymphomas and found no MALT-derived lymphomas.MALT-derived lymphomas were initially described in 1983 as a unique clinicopathologic entity associated with gastrointestinal lesions.These observations were expanded to include similar tumors involving other mucosal tissue. MALT-derived lymphoma is microscopically characterized by proliferation of follicle marginal zone cells (monocytoid B cells), often with surrounding reactive germinal centers, follicular colonization, Dutcher bodies, plasmacytic differentiation, and lymphoepithelial lesions.Lymphoepithelial lesions are composed of centrocytelike cells that have invaded the mucosal epithelium. When present, lymphoepithelial lesions are a distinct feature of MALT-derived lymphomas.In the past, these lesions were often described as pseudolymphomas or lymphoid hyperplasia because of their association with histologic features that suggested a benign or reactive process, including reactive follicles, preserved glandular architecture, and mixed inflammatory infiltrate. By using immunohistochemical techniques, we can now classify many cases as MALT-derived lymphoma.The immunohistochemical markers of MALT-derived lymphoma cells confirm B-cell lineage and usually include surface IgM+, cytosolic Ig+, CD19+, CD20+, and CD22+. The tumor cells are characteristically CD5−.Review of prior literature concerning sinonasal MALT lymphomas is difficult because various classification systems have been used. Extranodal lymphomas have no widely accepted classification system, a situation that results in overlapping and confusing terminology. For example, the term monocytoid B-cell lymphomahas been used to describe a low-grade, nodal or extranodal B-cell lymphoma manifesting clinical, histologic, and immunophenotypic features similar to MALT-derived lymphomas. Because of these similarities, some authorshave used the name marginal zone, B-cell lymphomato describe both lesions. As previously stated, recent immunohistochemical advances have allowed more precise subtyping. This inconsistent terminology could have limited our review of the literature, which revealed only 2 other cases of sinonasal MALT-derived lymphoma. In 1994, Isaacson and Nortonbriefly referred without details to a multifocal, B-cell, MALT-derived lymphoma involving both the nose and the larynx. Bhattacharyya et aldescribed a case involving the anterior wall of the right maxillary sinus in a 56-year-old woman. The patient also had gastric involvement and received chemotherapy and gastric external beam radiotherapy. According to the authors, the patient remained free of disease 2 years after treatment. In addition, one other possible case of sinonasal MALT-derived lymphoma was noted by Abbondanzo and Wenig.However, their specimen was not immunophenotyped, because no fresh or frozen tissue was available.Our case of primary sinonasal MALT-derived lymphoma was associated with symptoms and clinical examination results consistent with chronic sinusitis. Our case has features corresponding to current developmental theories of MALT-derived lymphomas. Most cases of MALT-derived lymphoma occur in sites devoid of native lymphoid tissue. The lymphoma arises from MALT accumulation due to chronic inflammation or autoimmune disease.MALT-derived lymphomas of the salivary glands always arise from myoepithelial sialadenitis, often in the setting of Sjögren disease.Similarly, gastric MALT-derived lymphomas are associated with chronic Helicobacter pyloriinfection.Like gastric mucosa, the sinonasal tract normally contains sparse lymphoid tissue. However, well-developed lymphoid follicles may be seen in chronic sinusitis. Our case may represent MALT accumulation due to chronic inflammation that then transformed into MALT-derived lymphoma. This case raises an etiologic question: Did chronic sinusitis cause the development of acquired MALT and the subsequent lymphoma, or did the lymphoma obstruct the osteomeatal complexes and thus lead to chronic sinusitis?MALT lymphomas are probably antigen driven, and regression has been observed when the antigen stimulus is withdrawn. For example, primary gastric MALT lymphomas can completely regress after eradication of H pyloriinfection.Clinical features of these lymphomas have been found to differ from nodal low-grade, B-cell lymphomas. MALT-derived lymphomas generally occur in adults, slightly more often in women.These indolent lesions appear to remain localized for long periods and often respond to local therapy, including excision and radiotherapy.Multifocal or disseminated lymphomas are treated with chemotherapy, with or without radiotherapy.Overall prognosis is better than that of nodal tumors of similar histologic grade.When disseminated, MALT-derived lymphomas involve other mucosal sites and appear to be incurable.Transformation to large-cell lymphomas can occur. In a recent study,patients with advanced-stage MALT lymphomas were treated with combination chemotherapy and had a median failure-free survival of only 2.3 years. This result suggests that such lymphomas carry a poor prognosis once disseminated.CONCLUSIONSFirst, primary MALT-derived lymphomas of the sinonasal tract are low-grade, B-cell NHL. Second, we believe that this is only the third case of sinonasal MALT-derived lymphoma reported, but that these tumors may be diagnosed with increasing frequency in the future because of technologic advances. Third, a theoretical "2-way" causative relation between chronic sinusitis and MALT-derived lymphoma is introduced. Fourth, treatment effectiveness remains to be determined.PGIsaacsonAJNortonExtranodal Lymphomas.Edinburgh, NY: Churchill Livingstone; 1994.WHWilderSGHarnerPMBanksLymphoma of the nose and paranasal sinuses.Arch Otolaryngol.1983;109:310-312.PGIsaacsonJSpencerMalignant lymphoma of mucosa-associated lymphoid tissue.Histopathology.1987;11:445-462.PIsaacsonDHWrightExtranodal malignant lymphoma arising from mucosa-associated lymphoid tissue.Cancer.1984;53:2515-2524.PIsaacsonDHWrightMalignant lymphoma of mucosa-associated lymphoid tissue: a distinctive type of B-cell lymphoma.Cancer.1983;52:1410-1416.TCDissACWotherspoonPSpeightLPanPGIsaacsonB-cell monoclonality, Epstein Barr virus, and t (14;18) in myoepithelial sialadenitis and low-grade B-cell MALT lymphoma of the parotid gland.Am J Surg Pathol.1995;19:531-536.H-PHornyAFerlitoACarboneLaryngeal lymphoma derived from mucosa-associated lymphoid tissue.Ann Otol Rhinol Laryngol.1996;105:577-583.HFFrierson JrSEMillsDJInnes JrNon-Hodgkin's lymphomas of the sinonasal region: histologic subtypes and their clinicopathologic features.Am J Clin Pathol.1984;81:721-727.EHannaJWanamakerDAdelsteinRTubbsPLavertuExtranodal lymphomas of the head and neck: a 20-year experience.Arch Otolaryngol Head Neck Surg.1997;123:1318-1323.ECampoACardesaLAlosNon-Hodgkin's lymphomas of nasal cavity and paranasal sinuses: an immunohistochemical study.Am J Clin Pathol.1991;96:184-190.RLiangDToddTKChanNasal lymphoma: a retrospective analysis of 60 cases.Cancer.1990;66:2205-2209.JADuncavageBHCampbellGAHansonDiagnosis of malignant lymphomas of the nasal cavity, paranasal sinuses, and nasopharynx.Laryngoscope.1983;93:1276-1280.SLAbbondanzoBMWenigNon-Hodgkin's lymphoma of the sinonasal tract: a clinicopathologic and immunophenotypic study of 120 cases.Cancer.1995;75:1281-1291.CFellbaumM-LHansmannKLennertMalignant lymphomas of the nasal cavity and paranasal sinuses.Virchows Arch Pathol Anat Histopathol.1989;414:399-405.EMBaileyJAFerryNLHarrisMCMihm JrJOJacobsonLMDuncanMarginal 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;20:1011-1023.RIFisherSDahlbergBNNathwaniPMBanksTPMillerTMGroganA clinical analysis of two indolent lymphoma entities: mantle cell lymphoma and marginal zone lymphoma (including the mucosa-associated lymphoid tissue and monocytoid B-cell subcategories): a Southwest Oncology Group study.Blood.1995;85:1075-1082.NBhattacharyyaRAFrankenthalerHIGomolinMEKadinAMLauretanoClinical and pathologic characterization of mucosa-associated lymphoid tissue lymphoma of the head and neck.Ann Otol Rhinol Laryngol.1998;107(9, pt 1):801-806.EBayerdörfferANeubauerBRudolphRegression of primary gastric lymphoma of mucosa-associated lymphoid tissue after cure of Helicobacter pyloriinfection: MALT Lymphoma Study Group.Lancet.1995;345:1591-1594.PGQuintanaSBKapadiaDWBahlerJTJohnsonSHSwerdlowSalivary gland lymphoid infiltrates associated with lymphoepithelial lesions: a clinicopathologic, immunophenotypic, and genotypic study.Hum Pathol.1997;28:850-861.Accepted for publication December 18, 1998.Presented at the annual meeting of the Bay Area Resident Research Symposium, Oakland, Calif, June 5, 1998.The Medical Editing Department, Kaiser Foundation Research Institute, Oakland, provided editorial assistance.Corresponding author: Raul M. Cruz, MD, Department of Head and Neck Surgery, Kaiser Permanente Medical Center, 280 W MacArthur Blvd, Oakland, CA 94611-5693 (e-mail: raul.cruz@ncal.kaiperm.org).

Journal

JAMA Otolaryngology - Head & Neck Surgery – American Medical Association

Published: May 1, 1999

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