Endobronchial involvement by non-Hodgkin’s lymphoma (NHL) is uncommon and usually occurs in the presence of more generalized disease. Solitary endobronchial lymphoma in the absence of disease elsewhere is extremely rare. In this report we describe a patient with an obstructing endobronchial mass which was the initial manifestation of NHL that was completely ablated by argon plasma coagulation via flexible videobronchoscopy.
78 years old lady was admitted into Intermediate Care Unit with one months’ history of progressively worsening dyspnea, dry cough and wheeze. She denied hemoptysis, fever, chest pain, weight loss and recent travel. Her past medical history was significant for hypertension and uterine cancer treated by total abdominal hysterectomy seven years ago. She never smoked in her life. Her physical exam was remarkable for diminished breath sounds in lower half of right lung zone. A CT scan of chest showed an endobronchial lesion in right intermediate bronchus, partially collapsing right lower lobe. There was no mediastinal lymphadenopathy. This led to bronchoscopy, which revealed completely obstructing lesion in right intermediate bronchus, at a level of right upper lobe take-off. This lesion was first biopsied and then completely ablated, using argon plasma coagulation. Pathology of the resected lesion revealed large B-cell lymphoma. Patient’s symptoms improved dramatically. Subsequently, head, abdomen and pelvic CT scans were unremarkable. A positron emission tomogram was also unremarkable. The patient was then treated with external beam radiation therapy followed by three cycles of CHOP chemotherapy. The patient remained tumor-free one year after the initial diagnosis.
Pulmonary non-Hodgkin’s lymphoma is usually seen in the presence of intra and/or extrathoracic disease. Solitary endobronchial mass with resultant atelectasis in the absence of systemic lymphoma is uncommon. The patients present with dyspnea, cough, wheeze, hemoptysis, chest pain and constitutional symptoms. Chemotherapy with or without radiotherapy is mainstem treatment. All patients should be treated with curative intent unless concomitant intercurrent illness precludes combination chemotherapy. If a relief of rapidly deteriorating dyspnea is desired, an airway obstruction may be relieved by a self-expanding endobronchial stent or tumor ablation by laser or Argon plasma coagulation.
Argon plasma coagulation is safe and effective additional treatment option for rapid resolution of symptoms associated with B-cell non-Hodgkin’s lymphoma presenting as an isolated endobronchial lesion.
Jennifer Toth, None.