Lung Cancer: Student/Resident Case Report Poster - Lung Cancer II |

Déjà Vu: The Return of Primary Pulmonary Lymphoma FREE TO VIEW

John Kern, DO; Yuriy Takhalov, MD
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Rutgers University, NJMS, Oceanport, NJ

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

Chest. 2016;150(4_S):755A. doi:10.1016/j.chest.2016.08.850
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SESSION TITLE: Student/Resident Case Report Poster - Lung Cancer II

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: Marginal Zone lymphoma constitutes 5% of non-Hodgkin’s lymphomas with the majority presenting in the gastrointestinal tract [1]. Primary Pulmonary disease is an exceedingly rare presentation representing 3.6% of cases of extranodal non-Hodgkin’s lymphomas[1,2] and less than 1% of primary pulmonary malignancies [1].

CASE PRESENTATION: A 62 year old woman with a history of chronic obstructive pulmonary disease, 35 pack year smoking, and low-grade B-cell lymphoma in remission presented to clinic for abnormal chest imaging and a dry non-productive cough for the past two months. The remainder of the review of systems was negative. Her exam was significant only for bilateral crackles at the lung bases. PET/CT demonstrated multiple abnormal foci of hypermetabolism corresponding to bilateral pulmonary nodular infiltrates with most intense uptake at the right parahilar region. There was no evidence of other foci of disease. She underwent bronchoscopy with transbronchial biopsy which revealed a low grade B-Cell Lymphoma most consistent with marginal zone lymphoma. Given lack of extra-pulmonary disease, a diagnosis of primary pulmonary lymphoma was made. She was treated with rituxamab weekly for eight weeks with a good response to treatment.

DISCUSSION: Primary pulmonary lymphoma (PPL) is a rare clonal lymphoid proliferation affecting the lungs with no detectable extrapulmonary disease within 3 months of the time of diagnosis [1,2,3]. In this case the patient had disease only present in the lung. In half of the cases of PPL, patients are asymptomatic with abnormal imaging prompting further evaluation [2]. Our patient presented with dry non-productive cough which is the most common presenting symptom occurring in up to 41% of cases [2]. PPL predominantly occurs in patients over 60 years of age with a history of chronic antigenic stimuli and resulting inflammation [2,3]. In a retrospective analysis of 223 patients with extranodal marginal zone pulmonary lymphoma 50% were noted to have a smoking history [2]. The optimal chemotherapeutic regiment has been not well defined at this time. Patients can undergo surgery, chemotherapy or radiation as part of their treatment regime.

CONCLUSIONS: Primary pulmonary lymphoma is an exceedingly rare disease with an indolent course often diagnosed on incidental imaging with absence of symptoms [2,3]. It is important to keep this rare disease in the differential for patients with a history of chronic antigenic stimuli [3].

Reference #1: Cadranel, et al.Primary pulmonary lymphoma. Eur Respir J 2002; 20: 750-762

Reference #2: Sammassimo S et al. A retrospective international study on primary extranodal marginal zone lymphoma of the lung (BALT lymphoma) on behalf of International Extranodal Lymphoma Study Group (IELSG). Hematol Oncol. 2015 Jul 7.

Reference #3: Richmond, et al. Bronchus associated lymphoid tissue (BALT) in human lung: its distribution in smokers and non-smokers. Thorax 48:1130-1134.

DISCLOSURE: The following authors have nothing to disclose: John Kern, Yuriy Takhalov

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