Lung Cancer |

A Rare Combination: Primary Pulmonary Lymphoma and Synchronous Cecal Adenocarcinoma FREE TO VIEW

Amina Saqib, MBBS; Uroosa Ibrahim, MBBS; Jasvinder Singh, MD; Rabih Maroun, MD
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Staten Island University Hospital, Staten Island, NY

Chest. 2015;148(4_MeetingAbstracts):573A. doi:10.1378/chest.2277358
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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: Synchronous cancers are a known entity with multiple primary carcinomas accounting for 3-5 % of colon cancers and multiple primary lung cancer incidence ranging from 0.2-20%. We report a case of synchronous Primary Pulmonary Non-Hodgkin’s B-cell Lymphoma and Cecal Adenocarcinoma. Primary NHL of the lung is rare, accounting for only 0.4% of all malignant lymphomas (1) and primary pulmonary lymphoma accompanied synchronously by colonic adenocarcinoma is an extremely rare occurrence.

CASE PRESENTATION: We present a 56 year old non-smoker male with a history of dyslipidemia, hypertension and COPD, referred to the pulmonologist after failing outpatient therapy for community acquired pneumonia and a CT chest showing an acute cutoff of the right middle lobe (RML) bronchus with post-obstructive atelectasis (A). Bronchoscopic findings showed inflammation with minimal narrowing of the right main bronchus and no endobronchial lesion. The bronchoalveolar lavage and endobronchial biopsy revealed atypical lymphocytosis and scant growth of Staphylococcus Aureus prompting antibiotic therapy resulting in resolution of cough and atelectasis (B). The presence of B cell predominant lymphocytosis raised the suspicion of a lymphoproliferative disorder prompting a Positron Emission Tomography scan that showed increased uptake in the RML bronchus and right hilar lymph node (C). Interestingly, focal increased uptake was also seen in the cecum (D). Endobronchial Ultrasound guided biopsy revealed a CD10 expressing clonal B cell population. A cecal biopsy revealed adenocarcinoma requiring cecal resection. A mediastinoscopy with biopsy of the right hilar lymph node was performed with the histopathlogic findings consistent with Primary Pulmonary B-cell Lymphoma. The patient was started on chemotherapy and is currently doing well on treatment.

DISCUSSION: Primary Pulmonary lymphomas are a rare disease and may present with cough, dyspnea, and hemoptysis with majority of the patients being asymptomatic (1). Signs and symptoms contribute little to the diagnosis like our patient who presented with cough in the setting of COPD as the only complaint. This report highlights the challenges associated with establishing an accurate diagnosis for these rare neoplasms. Although there are reports of synchronous occurrence of solid tumors with hematological malignancies, no pathological correlation has been established. This report raises the question of whether this synchrony is just a chance occurrence or if there is more than what meets the eye.

CONCLUSIONS: There are numerous reports of synchronous primary gastrointestinal and synchronous primary pulmonary neoplastic processes, however, to our knowledge this is the first report of a synchronous occurrence of tumors involving both the gastrointestinal and pulmonary systems i.e. adenocarcinoma of colon and primary pulmonary lymphoma.

Reference #1: Cadranel J, Wislez M, Antoine M. Primary pulmonary lymphoma. Eur Respir J. 2002;20:750-762.

DISCLOSURE: The following authors have nothing to disclose: Amina Saqib, Uroosa Ibrahim, Jasvinder Singh, Rabih Maroun

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