Primary B cell lymphoma of the bronchial mucosa is a rare entity. We present a case manifest initially with shortness of breath and unilateral wheezing.
A 74 y.o. woman (25 pack year former smoker) presented with gradual onset of shortness of breath on exertion and a nonproductive cough over a few months. She had an episode of hemoptysis but denied chest pain, fever, night sweats, or weight loss. On examination she was found to have wheezing noted only over the left hemithorax. A chest xray was normal and a CT scan (chest) showed circumferential narrowing of left mainstem bronchus. Bronchoscopy revealed a nodular appearance of the mucosa with narrowing of the distal left mainstem, left upper, and lower lobe bronchi. A similar nodular appearance without luminal narrowing was seen over the right upper lobe. Biopsies obtained from both sites showed mucosal-associated lymphoid tissue lymphoma (MALT) of the B cell type. CT scans of the abdomen and pelvis were normal.DISCUSSION: Primary MALT lymphoma of the bronchus, a rare entity, presented in this patient with unilateral wheezing. Initially the differential diagnosis included airway/endobronchial lesions such as neoplasm, foreign body, or fibrosis from TB or histoplasmosis. MALT lymphoma of the lung (one of the primary pulmonary lymphomas) is defined as clonal lymphoid proliferation affecting one or both lungs (parenchyma and/or bronchus) in a patient with no detectable extra pulmonary involvement at diagnosis or during the subsequent 3 months. Our patient’s presentation is unusual given the onset of unilateral wheezing in the presence of a normal chest xray (most patients with MALT lymphoma are asymptomatic with pulmonary parenchymal abnormalities noted on chest xray at presentation).
Primary MALT lymphoma of the lung is a rare entity. We present this unusual MALT lymphoma with unique presenting feature of unilateral wheeze.
K.R. Salahudeen, None.