This case involves a 56-year-old male patient who had dacryocystorhinostomy procedure to create a new tear drain between his eyes and nose. Pathology came back as benign. a little over a year later, the patient went for an evaluation of glaucoma. A second pathologist took a look at the previous surgical report and noted that the report indicated mucosa associated lymphoid tissue (MALT), which necessitated chemotherapy and radiation. An expert oncologist was sought to discuss the effects a 13-month delay might have on the treatment and prognosis of this patient.
Question(s) For Expert Witness
- 1. Do you routinely see patients with mucosa associated lymphoid tissue (MALT)?
- 2. Generally, what type of effect can a delay have on this type of patient?
Expert Witness Response E-034164
I spent the first 19 years of my career at Memorial Sloan Kettering Cancer Center in NYC where I directed the clinical research program in lymphoid leukemias. In 2009, I was recruited to be the inaugural Director of the Heme Malignancy and Bone Marrow Transplant program at Thomas Jefferson, a position I held until June, 2015. I have a great deal of expertise in low grade lymphoid malignancies such as MALT lymphomas. These are typically slow growing cancers but can “transform” into a more aggressive form which can be deadly. How much of an effect a 30-month delay would have on treatment and prognosis depends on the specifics of the case. It literally can range from no effect to life/death. I have reviewed several cases of failure to diagnose lymphoma in a timely manner but none of them have been of this specific sub-type.
Expert Witness Response E-009357
MALT lymphoma is a very indolent lymphoma that is often intentionally followed for years without treatment. Unless it transformed to a more aggressive histology or resulted in some irrevocable tissue damage due to growth in the interim, it is highly unlikely that the delay made a difference. That being said, MALT lymphoma would not receive chemotherapy and radiation outside of a few special circumstances. Most of the time it is treated with antibiotics or just radiation so I would be interested to see the records and learn more.