SESSION TYPE: Cancer Cases III
PRESENTED ON: Wednesday, October 24, 2012 at 11:15 AM - 12:30 PM
INTRODUCTION: Even though the incidence of Non-Hodgkin’s lymphomas (NHL) is increasing, the life expectancy has also increased. As a result, patients with NHL became at increased risk of second primary malignancies (1). Lung cancer is one of the solid cancers whose incidence increases in NHL patients (1). We describe a case of a synchronous squamous cell lung cancer that was missed originally in a patient diagnosed with non-Hodgkin’s lymphoma
CASE PRESENTATION: A 65-year-old male initially presented with low-grade fevers, axillary and inguinal lymph nodes enlargement. He underwent excisional lymph node biopsies, which were positive for diffuse B cell lymphoma. A PET scan showed diffuse uptake in multiple lymph node sites, as well as in the right lower lobe Fig (1). Three months after chemotherapy, a repeat PET scan showed interval increase in FDG activity of 61% within the right lower lobe that was stable in size and appearance, while there was an interval resolution of the multi-station lymphadenopathy in the other sites Fig (2). As a result, a bronchoscopy with endobronchial biopsy of the right lower lobe endobronchial lesion was performe. The biopsy result was suggestive of squamous cell lung cancer, which was confirmed by thoracoscopy and mediastinal lymph node dissection.
DISCUSSION: Non-Hodgkin’s lymphoma (NHL) is a malignant tumor of the lymphoid tissues. It is the sixth most common cause of mortality secondary to cancer and the seventh common cancer in the US. The five-year relative survival rate increased to 69%(2). As a result of this increase, the risk of second primary malignancies has also increased(1). The Surveillance, Epidemiology and End Results (SEER) data, showed that observed to expected ratio for developing subsequent primary cancers in NHL survivors was 1.18 for all sites and 3.08 for lung and bronchus(2) Even though synchronous occurrence of primary cancers such as lung cancer and NHL can exist, the challenge is to recognize lung lesions as a new or synchronous primary cancer rather than persistence or worsening of NHL, especially after a short course of chemotherapy.
CONCLUSIONS: In patients presenting with parenchymal lung lesions associated with mediastinal and peripheral lymphadenopathy, obtaining the diagnosis of cancer (NHL) after sampling the lymph nodes can mask the concurrent existence of lung cancer. Delaying lung cancer treatment will negatively affect the outcome, and therefore, it is crucial for the physician to recognize such group of patients and proceed with the biopsy of lung lesions irrespective of the Lymph node result.
1) Greene MH, Wilson J: Second cancer following lymphatic and hematopoietic cancers in Connecticut, 1935-82. Natl Cancer Inst Monogr 68:191-217,1985
2) Leukemia and Lymphoma society Facts 2010-2011.
DISCLOSURE: The following authors have nothing to disclose: Rabih Maroun, Kassem Harris, Michel Chalhoub
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