Lung Cancer |

Skin Rash and Lung Nodlue - What Can It Be? FREE TO VIEW

Khalid Sherani, MD; Hineshkumar Upadhyay, MD; Abhay Vakil, MBBS; Aashir Shah, MBBS; Kelly Cervellione, MPH; Alan Fein, MD
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Jamaica Hospital Medical Center, Jamaica, NY

Chest. 2015;148(4_MeetingAbstracts):532A. doi:10.1378/chest.2250834
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SESSION TITLE: Lung Cancer Case Report Posters II

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM

INTRODUCTION: Primary pulmonary lymphomas account for 0.5 % of all lung cancers with extra-nodal marginal zone lymphoma of MALT origin (MALT lymphoma) being extremely rare. Most patients with pulmonary MALT lymphoma are asymptomatic at presentation. We present the case of a patient presenting with skin rash and found to have mastocytosis on skin biopsy. Imaging studies performed to rule out systemic involvement in mastocytosis revealed a left upper lobe nodule. Histopathologic examination of the lung nodule showed pulmonary MALT lymphoma.

CASE PRESENTATION: A 66-year-old non-smoker female presented with worsening maculopapular skin rash for 6 weeks that started on her inner thighs, gradually progressing to involve all extremities. She reported loss of appetite with 10 pounds weight loss in last 1 month. She denied any cough, fever, hemoptysis, dyspnea or joint pain. Examination showed a non-blanching maculopapular rash involving all extremities with a positive Darier’s sign. Initial laboratory results are shown in Table 1. Skin biopsy confirmed the diagnosis of mastocytosis. Bone marrow examination followed by imaging studies performed to rule out systemic involvement in mastocytosis showed 2.1 x 0.9 cm left upper lobe nodule, multiple ground glass nodules and no lymphadenopathy. Bone marrow biopsy failed to show any abnormality. Due to high clinical suspicion for malignancy video-assisted thoracoscopic wedge resection of the lung nodule was performed, revealing nodular lymphoid aggregates with lymphoepithelial lesions (Fig.1). Immunohistochemical staining showed infiltration by CD20 positive B cells with aberrant CD43 expression and a negativity of the lymphoma cells for CD5, CD10and Bcl6 confirming the diagnosis of pulmonary MALT lymphoma.

DISCUSSION: Primary pulmonary MALT lymphoma, an extremely rare lung tumor, is almost always secondary to chronic stimulation by inflammatory or autoimmune processes. It can also be associated with paraproetinemia, mastocytosis and localized amyloid deposition. Surgical resection is almost curative with 5-year survival rates being greater than 90%.

CONCLUSIONS: Pulmonary lymphoproliferative disorders should be considered in the differential diagnosis of the patients presenting with lung nodules. Due to rarity of the disease, there is no established standard therapeutic strategy. For localized disease, surgical resection is the recommended treatment of choice.

Reference #1: Albores J, Fishbein M, Wang T. A 57-Year-Old Woman With Persistent Cough and Pulmonary Nodules. Chest. 2014; 145(5):1162-5.

DISCLOSURE: The following authors have nothing to disclose: Khalid Sherani, Hineshkumar Upadhyay, Abhay Vakil, Aashir Shah, Kelly Cervellione, Alan Fein

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