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Lung Pathology |

MALT Lymphoma of the Trachea

Jason Filopei, MD; Daniel Fein, MD; Navitha Ramesh, MD; Michael Bergman, MD; Sarun Thomas, MD; Samuel Acquah, MD
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Mount Sinai Beth Israel, New York, NY


Chest. 2015;148(4_MeetingAbstracts):610A. doi:10.1378/chest.2260376
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Abstract

SESSION TITLE: Lung Pathology Case Report Posters

SESSION TYPE: Affiliate Case Report Poster

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

INTRODUCTION: Mucosa associated lymphoid tissue (MALT) lymphoma of the trachea is an extremely rare disease1. We present to our knowledge the first case of recurrent disseminated MALT lymphoma where the trachea is the primary site involved.

CASE PRESENTATION: A 37-year-old woman previously treated for MALT lymphoma presented with cough, blood tinged sputum, and dysphonia. Physical revealed small bilateral supra-clavicular lymph nodes and several soft nodules on bilateral upper extremities and right buttock. CT scan of the chest revealed a circumferential mass spanning the intra-thoracic trachea (Figure 1A). Subsequent positron emission tomographic (PET) scanning showed hyper-metabolism of the tracheal lesion (SUV: 9.8) as well as in the arm and buttock (Figure 1B/C/D). The patient underwent bronchoscopy with endobronchial ultrasound guided needle aspiration of the R2 paratracheal lymph node. Immunohistochemistry staining and pathological analysis revealed Non Hodgkin MALT lymphoma (Figure 2). She was initiated on chemotherapy with rituximab, bendamustine and prednisone. Patient noted significant symptomatic improvement at 3 month follow up with resolution of tracheal abnormalities on PET scan.

DISCUSSION: MALT lymphoma is a low-grade extra-nodal B cell neoplasm that rarely progress beyond local disease or transforms into more aggressive disease2. The most commonly involved site is the gastrointestinal tract. In instances of respiratory involvement, disease usually manifests along the bronchovascular bundles of the lung. However, there are rare cases in which the trachea is the primary site of involvement. Our literature review yielded 7 such cases, six with tracheal disease alone and one with disseminated disease. The six patients with local disease responded well to surgery or radiation. The one patient with disseminated disease responded well to chemotherapy, similar to our case.

CONCLUSIONS: Pulmonary physicians should be aware that patients with a history of MALT lymphoma who present with respiratory complaints may have recurrence of disease with tracheal involvement. With the use of modern chemotherapeutic agents, patients with MALT lymphoma of the trachea may have excellent response to treatment without the use of radiotherapy or surgery.

Reference #1: Mira-Avendano I, Cumbo-Nacheli G, Parambil J. Mucosa-associated Lymphoid Tissue Lymphoma of the Trachea. J Bronchol Intervent Pulm Vol 19, No 1, Jan 2012.

Reference #2: Cohen SM, Petryk M, Varma M, et al. Non-Hodgkin’s lymphoma of mucosa-associated Oncologist. 2006;11:1100-1117.

DISCLOSURE: The following authors have nothing to disclose: Jason Filopei, Daniel Fein, Navitha Ramesh, Michael Bergman, Sarun Thomas, Samuel Acquah

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