Lung Cancer |

Primary Lung Lymphoma (PLL) Presenting With Pulmonary Nodules: A Clinical Puzzle FREE TO VIEW

Bikram Sharma, MBBS; Robert Lenox, MD
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SUNY Upstate Medical University, Syracuse, NY

Chest. 2014;146(4_MeetingAbstracts):658A. doi:10.1378/chest.1992057
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SESSION TITLE: Cancer Student/Resident Case Report Posters II

SESSION TYPE: Medical Student/Resident Case Report

PRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PM

INTRODUCTION: We are presenting a case of PLL presenting only as endobronchial lesion in a patient with bilateral small pulmonary nodules. PLL comprises of <1% of all primary lung neoplasms. Most cases are of B-cell origin. Our case is interesting as multiple CT scans as well as needle biopsy of the nodules failed to make a diagnosis.

CASE PRESENTATION: A 56 year old man presented with cough, dyspnea, and pleuritic chest pain. He smoked 30 pack years, had progressive fatigue, low grade fever and weight loss of 20 pounds in 6 months. A chest x-ray showed 9-mm pulmonary nodule. Chest CT revealed several pulmonary nodules bilaterally including right paratracheal lymph node. IR guided lymph node biopsy was negative for malignancy. He was treated with antibiotics with mild improvement. Needle biopsy of the paratracheal nodes revealed chronic inflammation only. Special stains for organisms were negative. PET scan revealed a 4.4cm mass in the left hilum. CT scan showed improvement compared to prior CT scans. Bronchoscopy revealed an endobronchial lesion which was biopsied. Markers for B cell were positive and it was and it was necrotic large B cell lymphoma. EBV stain was positive. Patient is currently being evaluated for further investigations and treatment.

DISCUSSION: PLL is a rare, low grade lymphoma of the lung which is histologically characterized by the aggregation of extranodal, monoclonal B- lymphoid cells near the bronchial epithelium. Patient may present with cough, fever, weight loss and night sweats. Characteristic CT findings, biopsy of the involved lymph nodes, bronchoscopy with lavage and biopsy, and rare cases open lung biopsy will be needed to make the diagnosis. In our patient the lymph node biopsy was negative. The left hilar lesion spontaneously resolved but the bronchoscopy was done because of persistence of symptoms and new small nodules.

CONCLUSIONS: Primary lymphoma of the lung often poses a diagnostic dilemma due to its rarity, nonspecific presentation and diverse radiographic findings. Differential diagnosis of pulmonary malignancy should include pulmonary lymphoma. Case reports would help to discover the various presentations and diagnostic approaches.

Reference #1: Hematology. 2011 Mar;16 (2):110-2. doi: 10.1179/102453311X12940641877722.Diffuse large B-cell lymphoma primary of lung.,Neri N1, Jesús Nambo M, Avilés A

Reference #2: Pulmonary lymphoma of the mucosa-associated lymphoid tissue type:report of a case with cytological, histological, immunophenotypical correlation, and review of the literature Claire W. Michael, MDa,T, Patti H. Richardson, MDb, Carole W. Boudreaux, MDca Department of Pathology, University of Michigan, Ann Arbor, Michigan, MI 48109-0054, USA

DISCLOSURE: The following authors have nothing to disclose: Bikram Sharma, Robert Lenox

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