Lung Cancer |

Bizarre Symptoms Due to an Exceptionally Rare Endotracheal Tumor FREE TO VIEW

Sultan Qanash, MD; Renelle Myers, MD
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University of Manitoba, Winnipeg, MB, Canada

Chest. 2015;148(4_MeetingAbstracts):530A. doi:10.1378/chest.2266013
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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: Mantle cell lymphoma (MCL) is a subtype of non-Hodgkin’s lymphoma. It is most often a very aggressive disease affecting multiple organs including lymph nodes, spleen, liver, gastrointestinal tract and bone marrow. Despite the frequency of extranodal manifestation of MCL, endobronchial involvement is the rarest intrathoracic manifestation even in the presence of advanced disease.

CASE PRESENTATION: A 74-year-old gentleman with a previous diagnosis of MCL. He was initially treated by six cycles chemotherapy and continued on maintenance Rituximab. Follow up examination and radiological imaging showed continued remission for 18-months. However, he began having shortness of breath and experiencing a chocking sensation with forward neck flexion, to the point of being unable to sleep. He had a computed tomography of the neck and chest that demonstrated endotracheal nodule arising from the left lateral wall measuring 12x13x13 mm(image-1). Flexible bronchoscopy demonstrated a polypoid lesion projected from the left wall of the proximal part of the trachea and narrowed the tracheal lumen by approximately 50%(image-2). Endobronchial biopsy confirmed the diagnosis of MCL. Chemotherapy was initiated which resulted in rapid tumor response, confirmed in a radiological imaging.

DISCUSSION: Endobronchial MCL is exceptionally rare and can be confused clinically with lung cancer, primary tracheal cancers, or other benign endobronchial lesions. It affects middle-aged patients with the median survival ranging from 3-5 years1. Endobronchial lymphoma can be either diffuse submucosal infiltrates originating from hematogenous or lymphangitic spread or localized mass due to direct spread or arising de novo from bronchus-associated lymphoid tissue2.

CONCLUSIONS: Endotracheal involvement was rarely reported in newly diagnosed or relapsing MCL. Our case was a relapsing MCL causing a critical airway obstruction, which is exceedingly rare. As most lymphomas respond adequately to systemic chemotherapy and radiotherapy, this may spare the patient a debulking surgical intervention. To our knowledge this is only the second case report of a critical airway lesion from MCL relapse.

Reference #1: Verde F, McGeehan A. Endotracheal involvement as an unusual extranodal site of recurrence from mantle cell lymphoma.Radiology Case Reports.[Online] 2008;3:194

Reference #2: Jang M, Choi YW, Jeon SC, Park C, Yoon HJ. Endobronchial non-Hodgkin's lymphoma presenting as an isolated endobronchial mass.Clinical radiology. 2006 Feb;61(2):202-5.PubMed PMID:16439227.Epub 2006/01/28.eng

DISCLOSURE: The following authors have nothing to disclose: Sultan Qanash, Renelle Myers

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