- Open Access
Imaging of head and neck mucosa-associated lymphoid tissue lymphoma (MALToma)
Cancer Imaging volume 21, Article number: 10 (2021)
Marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALToma) arises in extranodal sites in the head and neck. Chronic inflammatory, infectious or autoimmune conditions are implicated in its pathogenesis. Within the head and neck, MALToma is often multifocal and indolent and the imaging appearances may be mistaken for non-malignant disease in the head and neck. The aim of this article is to illustrate the varied radiological and clinical features of MALToma in the head and neck, an awareness of which is needed for timely and correct diagnosis to guide subsequent disease management.
MALToma is an extranodal B-cell non-Hodgkin lymphoma (NHL) and although it accounts for only7–9% of NHLs in the head and neck the incidence is on the rise [1, 2]. MALToma presents at mean age of 52–59 years but affects a wide age range of 21–92 years [1, 3] and unlike other head and neck NHLs is more prevalent in females [3, 4]. MALToma also differs from most other B-cell NHLs in that it has a predilection for salivary, thyroid and lacrimal glandular tissues and the orbits [1, 3, 4]. Chronic infection, inflammation and autoimmune disease lead to abnormal lymphoid proliferation predisposing to MALToma which arises within marginal zone B lymphocytes  and is often multifocal.
The indolent course of MALToma hinders diagnosis, especially in sites of pre-existing chronic disease. Distinction of an inflammatory process from MALToma is also challenging on fine needle aspiration cytology and image guided core biopsy is frequently used to balance diagnostic efficacy against the risk of an invasive open biopsy [6, 7]. The optimal treatment approach for MALToma is controversial. Early-stage disease is treated by radiotherapy alone [8,9,10,11] or for cases with MALToma of salivary and thyroid glands, by surgical resection, with or without adjuvant radiotherapy/chemotherapy . Advanced-stage disease is treated by a combination of radiotherapy and chemotherapy [11,12,13,14]. Other notable therapies are immunotherapy agents, which also alleviate background Sjögren’s disease  and antibiotics for Chlamydia-associated orbital MALToma . MALToma is difficult to cure and relapse is common, but 5-year overall survival is high (85–96%) for locally indolent disease . Transformation to high grade lymphoma and nodal / disseminated disease carry a worse prognosis .
General imaging features
On all imaging modalities MALToma produces solitary or multiple solid nodules which are usually homogeneous without cysts, necrosis or calcification (Figs. 1, 2, 3, 4, 5, 6, 7, 8). Tumour margins are usually well-defined but can be poorly-defined [7, 17, 18].
Ultrasound (US) is often the first investigation because of the superficial site of the glandular tissues in the head and neck. MALToma is markedly hypoechoic (Figs. 1, 2, and 8a), may contain fibrous striations comprising fine linear echogenic strands or wider denser echogenic bands [17,18,19,20] (Figs. 1, 2, and 8a) and shows internal vascularity on colour Doppler  (Fig. 8b). Internal striations and vascularity prevent misinterpreting a markedly hypoechoic MALToma for a cyst. Posterior acoustic enhancement is described [17,18,19] but is less frequently observed following advances in post-processing US technology [18, 21]. US also guides the site of biopsy.
Computed tomography (CT) and magnetic resonance imaging (MRI) are complementary to US and provide comprehensive evaluation of the whole head and neck region, encompassing all lymphatic, extra-lymphatic and nodal sites. MALToma is isoattenuating to mildly hyperattenuating , with mild to moderate contrast enhancement on CT [23, 24] (Figs. 7 and 8c). MRI provides better soft tissue contrast than CT, allowing depiction of subtle tumours, especially in a background of pre-existing chronic conditions that predispose to MALToma. The signal intensity of MALToma on MRI is low-intermediate on T1-weighted images, intermediate-mildly high on T2-weighted images, very low on apparent diffusion coefficient (ADC) maps and shows moderate contrast enhancement (Figs. 3, 4, 5, and 6). The ADC maps from diffusion weighted imaging (DWI) are especially useful in lesion characterisation because head and neck lymphoma, typically shows greater restriction of diffusion than most other cancers  or inflammatory processes  with an average ADC value of 0.65 × 10− 3 mm2/s, although much lower values are reported [27, 28]. Dynamic contrast-enhanced MRI or dual-phase contrast-enhanced CT can be helpful in lesion characterisation as MALToma exhibits earlier wash-in and higher relative washout than benign tumours or inflammatory processes such as pleomorphic adenoma  or IgG4-related disease [30, 31]. Hydrogen-proton MR spectroscopy (MRS) is deemed less useful because similar degrees of choline elevation are found in MALToma and benign lymphoepithelial lesions .
The role of 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) in MALToma is controversial. Early reports suggest low detection rates due to low FDG uptake of early-stage MALToma . However, in a recent meta-analysis the overall detection rate by FDG-PET-CT was 71%, being especially high in head and neck (90%) .
Nodal disease occurs in 21% of patients with non-gastric lymphoma . In the head and neck, enlarged nodes with typical lymphomatous features on imaging (round shape, loss or eccentric displacement of fatty hilum, and micronodular pattern on US ) are uncommon, although linear echogenic strands within hypoechoic nodes have been observed in MALToma . On the other hand, numerous small nodes are frequently encountered, and these may have reactive features , making them difficult to diagnose on any imaging modality (Fig. 9).
Site-specific clinical and imaging features
The salivary glands are the most common site of MALToma in the head and neck (46.5 to 81%). The parotid gland accounts for 80% of these MALTomas but as lymphoma accounts for less than 4% of parotid tumours it may be overlooked leading to unnecessary parotidectomy . Patients present with localized swelling, facial nerve palsy is uncommon (4–15%) . Sjögren’s disease is the major predisposing factor for MALToma; 20% of patients have underlying Sjögren’s disease  which increases the risk of MALToma by 44 times with a cumulative risk of 6% per year . Less common predisposing conditions are systemic lupus erythematosus, rheumatoid arthritis and IgG4-related disease , which can manifest as chronic sclerosing sialoadenitis in the submandibular gland .
Salivary gland MALToma presents as a solitary solid nodule/ mass in 35% of patients (Fig. 3) with imaging features as described above. Multifocal disease is common, seen in 65% of patients, and can involve single, bilateral or multiple salivary glands, as well as the lacrimal glands . On US, solid nodules can be markedly hypoechoic and mistaken for cysts (Fig. 1). MALToma may also manifest as multiple small hypoechoic solid nodules interspersed with linear echogenic septations of variable thickness which gives rise to a “tortoise-shell” pattern  (Figs. 1 and 2). Fibrous echogenic strands are described as fine lines within a hypoechoic area producing a “linear strand pattern” or wider producing a lobulated segmented pattern . Cysts and calcification have been reported in parotid MALToma; but, these features are difficult to separate from the underlying autoimmune/chronic inflammatory disease, which produces lymphoepithelial lesions that manifest as heterogeneous nodules, cysts (lymphoepithelial or secondary to obstructed ducts) and foci of calcification .
Differential diagnoses of salivary MALToma include
Salivary gland tumours: an in-depth discussion of the imaging features of benign and malignant salivary neoplasms is beyond the scope of this article. However, MALToma should be considered in cases with a homogeneous solid nodule/mass that shows marked diffusion restriction, multifocal disease and pre-existing chronic disease, especially Sjögren’s disease.
Sjögren’s disease: a simplified salivary gland US scoring system has been developed in which the likelihood of Sjögren’s disease is assigned a grade from 0 to 3. The appearance of grade 3, numerous confluent hypoechoic lesions, overlaps with that of MALToma (Fig. 2) . Therefore, in a gland with pre-existing Sjögren’s disease, a history of recent swelling and presence of dominant homogeneous solid nodule on imaging is important in identifying MALToma and guiding biopsy.
The orbit is the second most common site of MALToma in the head and neck . B-cell lymphomas account for 34% of primary orbital malignancies in adults above 60 years of age , most of which are MALToma. Common presentations are proptosis or palpable mass with little pain, inflammation or visual impairment . Conjunctival MALToma presents as a vascular fleshy mass over the conjunctiva . Orbital MALToma is indolent but despite initially favourable response to radiotherapy local relapse occurs in 25% of cases at 5 years and 45% at 10 years . Chronic bacterial infections from Chlamydia psittaci are reported in up to 89% of cases of ocular adnexal MALToma, hence antibiotics are used for treatment; IgG4-related dacryoadenitis is another predisposing factor .
Orbital MALToma presents as a solid nodule/ mass with imaging features as described above. It has a predilection for the superolateral quadrant of orbit where it involves the lacrimal gland and/or superior rectus muscle (Figs. 4, 5, and 6). Other sites include other extraocular muscles (especially lateral rectus muscle), conjunctiva, eyelids and extraconal and intraconal soft tissues (Fig. 6) . MALToma may be localised to one site or may spread to involve multiple adjacent sites, with bilateral disease (Fig. 5) in 15% of patients at presentation  (Figs. 5, 6, and 7). Bone erosion and hyperostosis are uncommon. Intraocular extension is also uncommon and suggests the rare possibility of intraocular uveal MALToma, which spreads outside the globe via the optic nerve . MRI is generally preferred over CT for orbital imaging due to better soft tissue contrast and avoidance of ionising radiation. The indolent nature of MALToma with long periods of quiescence is demonstrated in Fig. 7.
Differential diagnoses of orbital MALToma include
Metastasis: higher mean ADC (~ 1.20 × 10− 3 mm2/s) on DWI .
Thyroid orbitopathy: more likely to be bilateral, with retro-orbital fat oedema and involvement of multiple extra-ocular muscles (including inferior and medial rectus, which are less commonly affected in MALToma) occurring in a patient with thyroid disease.
Lacrimal gland carcinoma: more likely to be heterogeneous with adjacent bone scalloping or punctate calcification .
The thyroid is the third most common site of MALToma in the head and neck (10% of all cases) , often presenting with neck swelling. Although a rapidly enlarging painless goitre or compressive symptoms such as stridor, hoarseness and dysphagia are associated with high-grade B-cell lymphomas, this presentation has been observed in some low-grade MALTomas or in rare cases of transformation to high-grade lymphomas . Systemic dissemination is uncommon. Chronic inflammatory disease is a major predisposing factor , especially Hashimoto’s thyroiditis which is found in 92% of patients with thyroid MALToma ; Riedel’s thyroiditis is a less common risk factor .
Thyroid MALToma presents as a solid nodule/mass (Fig. 8) with imaging features as described above. These include markedly hypoechoic areas with internal vascularity and a striated appearance from linear echogenic strands and bands [17,18,19,20] (Fig. 8a and b). Partial destruction of these strands has been shown in an area of MALToma which contained more aggressive diffuse large B cell lymphoma components . MALToma presents with variable patterns which are similar to that seen in salivary gland MALToma and include a solitary lesion (Fig. 8), multiple lesions, diffuse pattern with intervening fibrous strands, nodular-segmental pattern or a mixture of these patterns [20, 54]. There is frequently a background of chronic parenchymal disease.
Differential diagnoses of thyroid MALToma include
Thyroid gland tumours: discussion of the imaging features of benign and malignant thyroid tumours is beyond the scope of this article, but MALToma should be considered when US shows solitary/multiple solid hypoechoic/ markedly hypoechoic homogeneous nodules with no cystic component or calcification, especially when there is a history of hypothyroidism or background parenchymal abnormalities consistent with Hashimoto’s disease.
Hashimoto’s disease: imaging appearance of diffuse MALToma may overlap with Hashimoto’s disease although MALToma tends to be of lower density on non-contrast enhanced CT images , lower echogenic on US and cause more asymmetrical enlargement of the right and left lobes . Like salivary gland MALToma, a history of recent swelling and evaluation for a dominant homogeneous solid nodule for biopsy are crucial. The value of PET-CT in such cases is controversial, although some reports suggest that thyroid MALTomas are more FDG-avid than the underlying chronic thyroiditis [55, 56].
About 12% of head and neck MALTomas arise at other sites in the head and neck, most commonly along the upper airway in Waldeyer’s ring and the larynx. Again, they are usually indolent but they may present with symptoms of luminal obstruction . MALToma may also arise in minor salivary gland tissues in the head and neck such as in the palate . The imaging features are similar to those described above. The main differential diagnosis of MALToma at these sites is squamous cell carcinoma which tends to show higher ADC values and is less commonly multifocal.
MALTomas in the head and neck are indolent lymphomas characterised by long periods of quiescence followed by relapse. They occur in extralymphatic sites, most notably the salivary glands, orbits and thyroid gland. They are often multifocal and arise at sites with pre-existing chronic disease (e.g. Sjögren’s disease in the salivary glands, chlamydial infection in the orbits and Hashimoto’s disease in the thyroid). MALTomas commonly manifest radiologically as solitary or multiple solid nodules that are fairly homogeneous without calcification or cysts, showing very low echogenicity, marked restriction of diffusion on DWI and low FDG activity. However, imaging findings may be confounded by presence of chronic disease. In such cases, a thorough search should be made to identify a dominant solid nodule. Awareness of clinical features and radiological appearances of MALToma with high index of suspicion are essential to make a radiological diagnosis of this entity to guide subsequent management.
Availability of data and materials
Apparent diffusion coefficient
Diffusion weighted imaging
18F-fluorodeoxyglucose positron emission tomography
Mucosa-Associated Lymphoid Tissue Lymphoma
Magnetic resonance imaging
Suh C, Huh J, Roh JL. Extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue arising in the extracranial head and neck region: a high rate of dissemination and disease recurrence. Oral Oncol. 2008;44(10):949–55.
Takano S, Matsushita N, Oishi M, Okamoto S, Teranishi Y, Yokota C, et al. Site-specific analysis of B-cell non-Hodgkin’s lymphomas of the head and neck: a retrospective 10-year observation. Acta Otolaryngol. 2015;135(11):1168–71.
Zucca E, Conconi A, Pedrinis E, Cortelazzo S, Motta T, Gospodarowicz MK, et al. Nongastric marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue. Blood. 2003;101(7):2489–95.
Wenzel C, Fiebiger W, Dieckmann K, Formanek M, Chott A, Raderer M. Extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue of the head and neck area: high rate of disease recurrence following local therapy. Cancer. 2003;97(9):2236–41.
Vega F, Lin P, Medeiros LJ. Extranodal lymphomas of the head and neck. Ann Diagn Pathol. 2005;9(6):340–50.
Howlett DC, Triantafyllou A. Evaluation: Fine Needle Aspiration Cytology, Ultrasound-Guided Core Biopsy and Open Biopsy Techniques. Adv Otorhinolaryngol. 2016;78:39–45.
Sharma A, Jasim S, Reading CC, Ristow KM, Villasboas Bisneto JC, Habermann TM, et al. Clinical Presentation and Diagnostic Challenges of Thyroid Lymphoma: A Cohort Study. Thyroid. 2016;26(8):1061–7.
Shum JW, Emmerling M, Lubek JE, Ord RA. Parotid lymphoma: a review of clinical presentation and management. Oral Surg Oral Med Oral Pathol Oral Radiol. 2014;118(1):e1–5.
Son SH, Choi BO, Kim GW, Yang SW, Hong YS, Choi IB, et al. Primary radiation therapy in patients with localized orbital marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT Lymphoma). Int J Radiat Oncol Biol Phys. 2010;77(1):86–91.
Laing RW, Hoskin P, Hudson BV, Hudson GV, Harmer C, Bennett MH, et al. The significance of MALT histology in thyroid lymphoma: a review of patients from the BNLI and Royal Marsden Hospital. Clin Oncol (R Coll Radiol). 1994;6(5):300–4.
Matutes E, Montalban C. Clinical features and management of non-gastrointestinal non-ocular extranodal mucosa associated lymphoid tissue (ENMALT) marginal zone lymphomas. Best Pract Res Clin Haematol. 2017;30(1–2):99–108.
Jones JM, Habermann TM, Ristow K, Kurtin P, McPhail E, Thompson CA, et al. Primary parotid MALT lymphoma: clinical characteristics and treatment – a single institution experience. Blood. 2011;118(21):1580.
Eckardt AM, Lemound J, Rana M, Gellrich NC. Orbital lymphoma: diagnostic approach and treatment outcome. World J Surg Oncol. 2013;11:73.
Thieblemont C, Mayer A, Dumontet C, Barbier Y, Callet-Bauchu E, Felman P, et al. Primary thyroid lymphoma is a heterogeneous disease. J Clin Endocrinol Metab. 2002;87(1):105–11.
Pijpe J, van Imhoff GW, Vissink A, van der Wal JE, Kluin PM, Spijkervet FK, et al. Changes in salivary gland immunohistology and function after rituximab monotherapy in a patient with Sjögren’s syndrome and associated MALT lymphoma. Ann Rheum Dis. 2005;64(6):958–60.
Ferreri AJ, Govi S, Pasini E, Mappa S, Bertoni F, Zaja F, et al. Chlamydophila psittaci eradication with doxycycline as first-line targeted therapy for ocular adnexae lymphoma: final results of an international phase II trial. J Clin Oncol. 2012;30(24):2988–94.
Ma B, Jia Y, Wang Q, Li X. Ultrasound of primary thyroid non-Hodgkin's lymphoma. Clin Imaging. 2014;38(5):621–6.
Li P, Zhang H. Ultrasonography in the Diagnosis and Monitoring of Therapy for Primary Thyroid Lymphoma. Ultrasound Q. 2019;35(3):246–52.
Luo J, Huang F, Zhou P, Chen J, Sun Y, Xu F, al e. Is ultrasound combined with computed tomography useful for distinguishing between primary thyroid lymphoma and Hashimoto's thyroiditis? Endokrynol Pol. 2019;70(6):463–8.
Orita Y, Sato Y, Kimura N, Marunaka H, Tachibana T, Yamashita Y, et al. Characteristic ultrasound features of mucosa-associated lymphoid tissue lymphoma of the salivary and thyroid gland. Acta Otolaryngol. 2014;134(1):93–9.
Ahuja AT, Ying M, Ho SY, Antonio G, Lee YP, King AD, et al. Ultrasound of malignant cervical lymph nodes. Cancer Imaging. 2008;8(1):48–56.
Cakmak PG, Çağlayan GA, Ufuk F. Extranodal lymphoma of the head and neck: a pictorial essay. Radiol Bras. 2019;52(4):268–71.
Narváez JA, Domingo-Domènech E, Roca Y, Romagosa V, De Lama E, González-Barca E, et al. Radiological features of non-gastric mucosa-associated lymphoid tissue lymphomas. Curr Probl Diagn Radiol. 2004;33(5):212–25.
Weber AL, Rahemtullah A, Ferry JA. Hodgkin and non-Hodgkin lymphoma of the head and neck: clinical, pathologic, and imaging evaluation. Neuroimaging Clin N Am. 2003;13(3):371–92.
Dai YL, King AD. State of the art MRI in head and neck cancer. Clin Radiol. 2018;73(1):45–59.
Şerifoğlu İ, Oz İİ, Damar M, Tokgöz Ö, Yazgan Ö, Erdem Z. Diffusion weighted imaging in the head and neck region: usefulness of apparent restricted diffusion coefficient values for characterization of lesions. Diagn Interv Radiol. 2015;21(3):208–14.
Thoeny HC, De Keyzer F, King AD. Diffusion-weighted MR imaging in the head and neck. Radiology. 2012;263(1):19–32.
Maeda M, Maier SE. Usefulness of diffusion-weighted imaging and the apparent diffusion coefficient in the assessment of head and neck tumors. J Neuroradiol. 2008;35(2):71–8.
Zhu L, Zhang C, Hua Y, Yang J, Yu Q, Tao X, et al. Dynamic contrast-enhanced MR in the diagnosis of lympho-associated benign and malignant lesions in the parotid gland. Dentomaxillofac Radiol. 2016;45(4):20150343.
Priego G, Majos C, Climent F, Muntane A. Orbital lymphoma: imaging features and differential diagnosis. Insights Imaging. 2012;3(4):337–44.
Gerbino G, Boffano P, Benech R, Baietto F, Gallesio C, Arcuri F, et al. Orbital lymphomas: clinical and radiological features. J Craniomaxillofac Surg. 2014;42(5):508–12.
Zhu L, Wang J, Shi H, Tao X. Multimodality fMRI with perfusion, diffusion-weighted MRI and 1 H-MRS in the diagnosis of lympho-associated benign and malignant lesions of the parotid gland. J Magn Reson Imaging. 2019;49(2):423–32.
Perry C, Herishanu Y, Metzer U, Bairey O, Ruchlemer R, Trejo L, et al. Diagnostic accuracy of PET/CT in patients with extranodal marginal zone MALT lymphoma. Eur J Haematol. 2007;79(3):205–9.
Treglia G, Zucca E, Sadeghi R, Cavalli F, Giovanella L, Ceriani L. Detection rate of fluorine-18-fluorodeoxyglucose positron emission tomography in patients with marginal zone lymphoma of MALT type: a meta-analysis. Hematol Oncol. 2015;33(3):113–24.
Cui XW, Jenssen C, Saftoiu A, Ignee A, Dietrich CF. New ultrasound techniques for lymph node evaluation. World J Gastroenterol. 2013;19(30):4850–60.
Mehle ME, Kraus DH, Wood BG, Tubbs R, Tucker HM, Lavertu P. Lymphoma of the parotid gland. Laryngoscope. 1993;103(1 Pt 1):17–21.
Picard A, Cardinne C, Denoux Y, Wagner I, Chabolle F, Bach CA. Extranodal lymphoma of the head and neck: a 67-case series. Eur Ann Otorhinolaryngol Head Neck Dis. 2015;132(2):71–5.
Kato H, Kanematsu M, Goto H, Mizuta K, Aoki M, Kuze B, et al. Mucosa-associated lymphoid tissue lymphoma of the salivary glands: MR imaging findings including diffusion-weighted imaging. Eur J Radiol. 2012;81(4):612–7.
Kassan SS, Thomas TL, Moutsopoulos HM, Hoover R, Kimberly RP, Budman DR, et al. Increased risk of lymphoma in sicca syndrome. Ann Intern Med. 1978;89(6):888–92.
Wöhrer S, Troch M, Streubel B, Zwerina J, Skrabs C, Formanek M, et al. MALT lymphoma in patients with autoimmune diseases: a comparative analysis of characteristics and clinical course. Leukemia. 2007;21(8):1812–8.
Ochoa ER, Harris NL, Pilch BZ. Marginal zone B-cell lymphoma of the salivary gland arising in chronic sclerosing sialadenitis (Küttner tumor). Am J Surg Pathol. 2001;25(12):1546–50.
Ando M, Matsuzaki M, Murofushi T. Mucosa-associated lymphoid tissue lymphoma presented as diffuse swelling of the parotid gland. Am J Otolaryngol. 2005;26(4):285–8.
Bahn YE, Lee SK, Kwon SY, Kim SP. Sonographic appearances of mucosa-associated lymphoid tissue lymphoma of the submandibular gland confirmed with sonographically guided core needle biopsy. J Clin Ultrasound. 2011;39(4):228–32.
Theander E, Mandl T. Primary Sjögren's syndrome: diagnostic and prognostic value of salivary gland ultrasonography using a simplified scoring system. Arthritis Care Res. 2014;66(7):1102–7.
Cabeçadas J, Martinez D, Andreasen S, Mikkelsen LH, Molina-Urra R, Hall D, et al. Lymphomas of the head and neck region: an update. Virchows Arch. 2019;474(6):649–65.
Fung CY, Tarbell NJ, Lucarelli MJ, Goldberg SI, Linggood RM, Harris NL, et al. Ocular adnexal lymphoma: clinical behavior of distinct World Health Organization classification subtypes. Int J Radiat Oncol Biol Phys. 2003;57(5):1382–91.
McKelvie PA. Ocular adnexal lymphomas: a review. Adv Anat Pathol. 2010;17(4):251–61.
Freedman K, Shenoy S. Mucosa-associated lymphoid tissue lymphoma with intraocular and orbital involvement: case presentation and review of the literature. Orbit. 2018;37(4):243–7.
Sepahdari AR, Politi LS, Aakalu VK, Kim HJ, Razek AA. Diffusion-weighted imaging of orbital masses: multi-institutional data support a 2-ADC threshold model to categorize lesions as benign, malignant, or indeterminate. AJNR Am J Neuroradiol. 2014;35(1):170–5.
Moon WJ, Na DG, Ryoo JW, Kim MJ, Kim YD, Lim DH, et al. Orbital lymphoma and subacute or chronic inflammatory pseudotumor: differentiation with two-phase helical computed tomography. J Comput Assist Tomogr. 2003;27(4):510–6.
Xian J, Zhang Z, Wang Z, Li J, Yang B, Man F, et al. Value of MR imaging in the differentiation of benign and malignant orbital tumors in adults. Eur Radiol. 2010;20(7):1692–702.
Kiesewetter B, Lamm W, Dolak W, Lukas J, Mayerhoefer ME, Weber M, et al. Transformed mucosa-associated lymphoid tissue lymphomas: A single institution retrospective study including polymerase chain reaction-based clonality analysis. Br J Haematol. 2019;186(3):448–59.
Miki K, Orita Y, Sato Y, Sugitani I, Noyama M, Fuji S, et al. Mucosa-associated lymphoid tissue lymphoma of the thyroid with abundant IgG4-positive plasma cells. Auris Nasus Larynx. 2013;40(6):587–90.
Wang Z, Fu B, Xiao Y, Liao J, Xie P. Primary thyroid lymphoma has different sonographic and color Doppler features compared to nodular goiter. J Ultrasound Med. 2015;34(2):317–23.
Schmid DT, Kneifel S, Stoeckli SJ, Padberg BC, Merrill G, Goerres GW. Increased 18F-FDG uptake mimicking thyroid cancer in a patient with Hashimoto's thyroiditis. Eur Radiol. 2003;13(9):2119–21.
Lee CJ, Hsu CH, Tai CJ, Lin SE. FDG-PET for a thyroid MALT lymphoma. Acta Oncol. 2008;47(6):1165–7.
Laskar S, Mohindra P, Gupta S, Shet T, Muckaden MA. Non-Hodgkin lymphoma of the Waldeyer's ring: clinicopathologic and therapeutic issues. Leuk Lymphoma. 2008;49(12):2263–71.
Yonal-Hindilerden I, Hindilerden F, Arslan S, Turan-Guzel N, Dogan IO, Nalcaci M. Primary B-Cell Mucosa-Associated Lymphoid Tissue Lymphoma of the Hard Palate and Parotid Gland: Report of One Case and Review of the Literature. J Clin Med Res. 2016;8(11):824–30.
Ethics approval and consent to participate
We have ethical approval from The Joint Chinese University of Hong Kong – New Territories East Cluster Clinical Research Ethics Committee (CREC Ref. No. 2019.709) in which patient consent is waived.
Consent for publication
The authors declare that they have no competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
This article reviews the radiological and clinical features of extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALToma) in the head and neck. Due to the indolent nature of MALToma and co-existence with pre-existing chronic disease it often mimics non-malignant disease. A high index of suspicion is therefore required to make the correct diagnosis.
About this article
Cite this article
Ko, K.W.S., Bhatia, K.S., Ai, Q.Y.H. et al. Imaging of head and neck mucosa-associated lymphoid tissue lymphoma (MALToma). Cancer Imaging 21, 10 (2021). https://doi.org/10.1186/s40644-020-00380-5
- Mucosa-associated lymphoid tissue
- Marginal zone B-cell lymphoma
- Head and neck