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Lung Cancer |

Finding Room to Breathe Within Narrow Margins

Lian Szabo, MD; Julie Jarand, MD
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Faculty of Medicine - University of Calgary, Calgary, AB, Canada


Chest. 2015;148(4_MeetingAbstracts):574A. doi:10.1378/chest.2272480
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Abstract

SESSION TITLE: Lung Cancer Student/Resident Case Report Posters

SESSION TYPE: Student/Resident Case Report Poster

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

INTRODUCTION: The lung is a common site for secondary lymphoma with an incidence of 25-40%. However, primary non-Hodgkin’s lymphoma of the lung is rare[1]. The clinical presentation and imaging findings are variable and thus pathology is essential for diagnosis.

CASE PRESENTATION: A 55 year old female smoker presented with 3 months of progressive dyspnea and productive cough. She was initially treated with a course of levofloxacin with minimal improvement. The initial chest x-ray was markedly abnormal with bilateral infiltrates (Figure 1A). On initial assessment by Respirology, her oxygen saturation was severely reduced at 78% on room air. Her physical exam was remarkable for a few scattered wheezes and crackles. Complete blood count was normal. Spirometry showed moderate airflow obstruction. Diffusion was 41% predicted. Computed tomography of the chest revealed extensive bilateral ground glass opacities in the upper and mid lung zones with sparing of the bases and bilateral hilar lymphadenopathy (Figure 1C). Flexible bronchoscopy was performed. Transbronchial biopsies and bronchoalveolar lavage flow cytometry were consistent with extranodal marginal zone B-cell lymphoma which was CD20 and BCL-2 positive. Further immunohistochemistry was negative for CD5, CD10 and cyclinD1. She was referred to Hematology for treatment and initiated on bendamustine and rituximab with an excellent physiologic, clinical and radiologic response (Figure 1B and 1D).

DISCUSSION: Primary pulmonary lymphomas are a rare entity, accounting for 3-4% of all extranodal types[1]. Most are marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue type (MALT). Our case describes this rare entity, but one that presented with advanced pulmonary disease including profound hypoxemia and significant radiologic abnormality. Usually this pathology is associated with nodular or consolidative patterns. However, such as in our case, ground-glass attenuation is not a frequent finding, with an incidence of 6%-10%[2]. Although the disease is indolent, it rarely resolves without treatment[3]. Our case demonstrates the excellent clinical and radiologic response to treatment that can occur even with advanced disease.

CONCLUSIONS: 1) Primary pulmonary lymphomas are rare. 2) These can present in many ways, including sub-acute progressive dyspnea and hypoxemia. 3) Pathologic diagnosis and appropriate treatment is essential, as significant recovery is obtainable.

Reference #1: Ferraro P et al. Primary non-Hodgkin’s Lymphoma of the Lung. Ann Thorac Sur. 2000; 69:993-7.

Reference #2: Young AB et al. Marginal Zone B-Cell Lymphoma of Bronchus-Associated Lymphoid Tissue. Chest. 2008; 133(2):433-40.

Reference #3: Zinzani PL et al. Extranodal Marginal B-Cell Lymphoma of MALT-type of the Lung. Leukemia and Lymphoma. 2003;44(5):821-4.

DISCLOSURE: The following authors have nothing to disclose: Lian Szabo, Julie Jarand

No Product/Research Disclosure Information


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