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Definitive diagnosis was achieved using EBUS-guided transbronchial cryobiopsy with immunohistochemistry and molecular clonality, confirming extranodal marginal zone lymphoma (MALT type) and stage IV disease on 68Ga-CXCR4 PET/CT, supporting active surveillance in an asymptomatic patient.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/diagnostic-challenges-and-management-strategies-of-pulmonary-mucosa-associated-lymphoid-tissue-lymphoma-a-case-report-and-literature-review/409961/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/diagnostic-challenges-and-management-strategies-of-pulmonary-mucosa-associated-lymphoid-tissue-lymphoma-a-case-report-and-literature-review/409961.png","ImageObject",300,407,{"name":42,"@type":43},"Riley","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-30","2026-09-28",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",14,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"Why is diagnosing pulmonary MALT lymphoma challenging?","Question",{"text":63,"@type":64},"Its clinical and radiological features are nonspecific and can resemble infections, inflammatory diseases, or other malignancies. Small biopsy samples may also yield inconclusive results.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"What diagnostic steps led to the definitive diagnosis in the case?",{"text":68,"@type":64},"Initial transbronchial forceps biopsy and bronchoalveolar lavage next-generation sequencing were non-specific and showed no pathogens. Endobronchial ultrasound-guided transbronchial cryobiopsy provided larger tissue, and immunohistochemistry plus molecular testing confirmed clonality and the MALT type.",{"name":70,"@type":61,"acceptedAnswer":71},"How was the disease staged and what management approach was used?",{"text":72,"@type":64},"68Ga-CXCR4 PET/CT demonstrated hypermetabolism in bilateral pulmonary opacities and multiple nodal stations, indicating stage IV disease. 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Med. 12:1719542 .  \ndoi: 10.3389/fmed.2025.1719542  \nCOPYRIGHT  \n© 2025 Tang, Yang and Bai. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.  \nTYPE Case Report  \nPUBLISHED 18 December 2025 DOI 10.3389/fmed.2025.1719542  \nDiagnostic challenges and management strategies of pulmonary mucosa-associated lymphoid tissue lymphoma: a case report and literature review  \nJian Tang 1, Bijun Yang 2* and Yang Bai 2*  \n1Department of Respiratory and Critical Care Medicine, The People's Hospital of Neijiang Dongxing District, Neijiang, China, 2Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China  \nBackground: Pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma is a rare extranodal B-cell lymphoma, representing the most common primary pulmonary lymphoma (\u003C 0. 5% of all lung malignancies) . Diagnosis is difficult because of its nonspecific clinical and radiological characteristics, which often resemble infections, inflammatory diseases, or other malignancies. Typical imaging findings include nodules, consolidations, or, less frequently, interstitial patterns such as ground-glass opacities. A conclusive diagnosis requires histological examination, augmented by immunohistochemistry and molecular investigations, to confirm clonality. Conventional biopsies may yield inconclusive outcomes due to small sample size and delicate cytologic atypia. Case presentation: A 36-year-old non-smoking Asian female with no history of pulmonary tuberculosis, malignancies, or autoimmune disorders was incidentally found to have patchy opacities in the left lower lobe on routine chest radiographyin January 2024. She remained asymptomatic over the 18-month disease progression period, lacking respiratory or systemic symptoms, whereas follow-up imaging indicated progression to bilateral, multifocal flocculent opacities. Initial investigations, including transbronchial forceps biopsy and bronchoalveolar lavage fluid analysis through next-generation sequencing, reported only non-specific chronic inflammation and no pathogens. Empirical treatment with moxifloxacin (400 mg daily for 14 days), targeting common pathogens of community-acquired pneumonia, yielded no improvement. A definitive diagnosis was achieved by endobronchial ultrasound-guided transbronchial cryobiopsy (EBUS-TBCB), which produced larger, well-preserved tissue specimens. Histopathological and  \nimmunohistochemical examination indicated a dense, angiocentric infiltration of CD20-positive B cells, accompanied by monoclonal rearrangement of immunoglobulin genes, confirming extranodal marginal zone lymphoma of the MALT type. Staging with 68Ga-CXCR4 positron emission tomography (PET)/ computed tomography (CT) demonstrated hypermetabolism in bilateral pulmonary opacities and multiple nodal stations, indicative of stage IV disease. Consi","cbCaiprHvdlguh0f","https://ap.wps.com/l/cbCaiprHvdlguh0f","pdf",1423533,"English","# Background\n# Case presentation\n# Conclusion\n# Introduction\n# Keywords","[{\"question\":\"Why is diagnosing pulmonary MALT lymphoma challenging?\",\"answer\":\"Its clinical and radiological features are nonspecific and can resemble infections, inflammatory diseases, or other malignancies. Small biopsy samples may also yield inconclusive results.\"},{\"question\":\"What diagnostic steps led to the definitive diagnosis in the case?\",\"answer\":\"Initial transbronchial forceps biopsy and bronchoalveolar lavage next-generation sequencing were non-specific and showed no pathogens. Endobronchial ultrasound-guided transbronchial cryobiopsy provided larger tissue, and immunohistochemistry plus molecular testing confirmed clonality and the MALT type.\"},{\"question\":\"How was the disease staged and what management approach was used?\",\"answer\":\"68Ga-CXCR4 PET/CT demonstrated hypermetabolism in bilateral pulmonary opacities and multiple nodal stations, indicating stage IV disease. Because the patient was asymptomatic with excellent performance status, active surveillance was recommended.\"}]","Diagnostic challenges and management strategies of pulmonary mucosa-associated lymphoid tissue lymphoma - a case report and literature review | PDF",1790583788,15]