SESSION TYPE: Cancer Case Report Posters II
PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM
INTRODUCTION: Primary pulmonary lymphoma (PPL), a rare form of lung cancer is seen in 0.5-1 percent of all lung cancers. The marginal B cell lymphoma (MBCL) is the commonest of this group and it is generally a low grade with indolent course. Metachronous lung cancers develops in 1-2% patient per year in patients successfully treated for primary lung cancer. We report a unique case of simultaneous occurrence of pulmonary squamous cell carcinoma (SCC) and MBCL within the same lesion diagnosed on bronchoscopic lung biopsy.
CASE PRESENTATION: A 66 year-old smoker woman, was evaluated for persistent right upper and lower lobe masses on a surveillance chest CT with positive standard uptake (SVU 5.6) on PET scan (Image 1A). Clinical exam and laboratory were normal. CT showed lung nodules without mediastinal lymphadenopathy (ML). She presented 4-years ago for dyspnea, cough and bilateral lung infiltrates and a spiculated lingular lesion and ML. Video assisted thoracoscopy with lingula resection and ML biopsy revealed MBCL. She was lost for follow up but presented two-years later with similar symptoms and worsening right upper lobe infiltrate and ML (Image 1B). Bronchoscopic transbronchial biopsy (TBBx) and EBUS-TBNA confirmed the previous diagnosis of MBCL. Patient received chemotherapy with good clinical response. Surveillance PET/CT revealed persistent lesions with high SVU which prompted pulmonary evaluation. In order to evaluate for transformation of MBCL to large cell lymphoma, bronchoscopy was performed. TBBx revealed MBCL of MALT type (Image 2A) and a well-differentiated SCC (Image 2B).
DISCUSSION: The first description of MPLC was by Beyreuther and refers to synchronous and metachronous tumors. The prevalence of MPLC remains unclear and varies from 1%-10%. The definition of PPL is “clonal lymphoid proliferation affecting one or both lungs (parenchyma and/or bronchi) in a patient with no detectable extrapulmonary involvement at diagnosis or during the subsequent 3 months”. There are reports of the coexistence of different types of lung carcinomas and malignant lymphomas but to our knowledge this is the first report of synchronous occurrence of pulmonary SCC and MBCL. The persistent lesions with hyperactive PET in our patient suggested transformation of MBCL to high grade proliferation. The increased incidence of transformation in this group of patients mandates serial imaging surveillance. Tissue diagnosis is critical to decide on therapy in this group of patients who either relapse or respond partially to chemotherapy.
CONCLUSIONS: Our case reveals the importance of diagnostic bronchoscopy in patients with non resolving lymphomas.
1) S. Chanel, L. Burke, M. Fiche et al., “Synchronous pulmonary adenocarcinoma and extranodal marginal zone/low-grade B-cell lymphoma of MALT type,” Human Pathology, vol. 32, no. 1, pp. 129-132, 2001
DISCLOSURE: The following authors have nothing to disclose: Muhammad Adrish, Gilda Diaz-Fuentes, Masooma Niazi, Sindhaghatta Venkatram
No Product/Research Disclosure InformationBronx Lebanon Hospital Center, Bronx, NY