Lung Cancer: Lung Cancer |

Lung No Hodgkin Lymphoma (NHL): A Case Report FREE TO VIEW

Mara Rubia Lima, MD; Ana Moreira, MD; Bruno Hochhegger, MD; Felipe Sanches, MD; Beatriz Mantuan; Fernanda Oliveira; Camila Ventura
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UFCSPA, Porto Alegre, Brazil

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A263. doi:10.1016/j.chest.2016.02.275
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SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, April 17, 2016 at 11:45 AM - 12:45 PM

INTRODUCTION: No Hodgkin Lymphoma (NHL) describes several cancers of lymphoid origin that form a heterogeneous group of diseases defined by morphological, immunophenotypic and genetic that can affect the mucosa-associated lymphoid tissue (MALT), which is not identified in normal lung tissue but can develop after chronic antigen stimulation undergoing secondary lymphomatous transformation. Primary lung lymphoma is rare (<1% of malignant primary lung tumors, <1% of all lymphomas).

CASE PRESENTATION: 67 year-old female, retired teacher. Former smoker (30 years/pack) with asthma since childhood, started in August 2010 with fatigue, dyspnea mMRC 2, persistent cough and heartburn. Clinical examination:regular general condition, acyanotic, wheezing in lower left third, no clubbing. GERD diagnosed by pH monitoring. Normal spirometry. Chest x-ray, chest tomography and PET CT show retrocardiac soft tissue lesion measuring 7cm in major axis. Systemic cancer staging with no abnormalities. Computarized Tomography (CT) guided biopsy obtained a sample which immunohistochemistry confirmed mucosa-associated lymphoid tissue (MALT) lymphomas. Treated with chemotherapy performed with R-CVP protocol for 6 cycles had no adverse events. Cough progressively disappeared. Currently asymptomatic with normal chest PETCT and CT.

DISCUSSION: One third of patients are asymptomatic. More frequent ymptoms are cough, low fever, weight loss and chronic fatigue. Diagnosis can be difficult by the fact that CT can show different patterns. Hybrid methods, such as PET-CT, may be useful but definitive diagnosis is pathological. There are two types: B-cell lymphoma of low and high grade. More than 90% of MALT are of low grade B-cell and usually respond well to chemotherapy, including remission, as in the case of this patient.

CONCLUSIONS: Although rare, early diagnosis of Lung No Hodgkin lymphoma is very important and chemotherapy can lead to remission of the disease.

Reference #1: Pajares V, et al. Recidiva endobronquial de linfoma difuso de células grandes B. Diagnóstico con criosonda. Arch Bronconeumol. 2013;49:210-2.

Reference #2: Chest. 2014 Sep;146(3):e92-6. doi: 10.1378/chest.13-2790. A 54-year-old man referred with nonresolving pneumonia. Catteeuw J, Koegelenberg CF, Bruwer JW, Sissolak G, Schroeter L, Mohamed N, Irusen EM.

Reference #3: Kohan A, et al. Linfoma intravascular pulmonar detectado mediante FDG PET-TC: a propósito de un caso. Rev Esp Med Nucl Imagen Mol. 2012;32:318-20.

DISCLOSURE: The following authors have nothing to disclose: Mara Rubia Lima, Ana Moreira, Bruno Hochhegger, Felipe Sanches, Beatriz Mantuan, Fernanda Oliveira, Camila Ventura

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