A Case of Baltoma Diagnosed by Transthoracic True-Cut Needle Biopsy

We describe a 73-year-old patient with symptoms of chest pain, he­moptysis, malaise and weight loss for two years. Airspace consolida­tions with air bronchograms in right middle and both lower lobes were observed radiologically. For fiberoptic bronchoscopy was non­diagnostic, transthoracic true-cut needle biopsy was performed un­der CT guidence. Histological examination of lung biopsy revealed replacement of normal lung parenchyma with diffuse infiltration of monotonous cells with scanty cytoplasma and little nuclear irregu­larity. In immunohistochemical examination it was detected that the LCA and B cell markers of the cells were stained positive for CD20 and CD79; whereas epithelial markers were stained negative for cytokeratin and EMA, and T cell markers were stained negative for CD3. The histopathological features were reported to be compa­tible with primary pulmonary BALT (bronchus-associated lympho­id tissue) lymphoma or baltoma. We recommend that baltoma should be included in differential di­agnosis of patients with slow-progressing pulmonary symptoms and airspace consolidation. Transthoracic true-cut needle biopsy under CT guidence might provide sufficient tissue in peripheral lung lesi­ons for immunologic studies.