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

An Uncommon Presentation of Extranodal Lymphoma FREE TO VIEW

Audra Fuller, MD; Ebtesam Islam, MD; Raed Alalawi, MD
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TTUHSC, Lubbock, TX

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

Chest. 2016;150(4_S):764A. doi:10.1016/j.chest.2016.08.859
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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: Extranodal lymphoma involving the endotracheal region is rare.

CASE PRESENTATION: Case 1: A 57 y/o female with recently diagnosed hypothyroidism presented with worsening SOB, stridor and dysphagia for 6 weeks. CT scan showed a lower neck soft tissue mass encasing and invading the subglottic larynx, trachea and esophagus and large cervicothoracic region mass. Biopsy showed mantle cell lymphoma and she underwent a thyroid isthmusectomy and tracheostomy. She completed 3 rounds of chemotherapy and her tracheostomy was removed 2 months later. She was doing well until 3 months later when she developed worsening stridor and SOB. On admission she had loud inspiratory stridor, expiratory wheezing and decreased air movement bilaterally. CT neck showed decrease in the size of the infiltrative mass involving the thyroid gland and 50% focal narrowing of the subglottic airway. Bronchoscopy showed 60% tracheal occlusion by an endobronchial mass. The mass was debulked using cautery knife and cryoprobe. Balloon dilation was then performed. The end result was less than 10% tracheal stenosis. She experienced significant improvement in her dyspnea and stridor. Pathology from the tracheal mass again revealed high grade, large B cell, malignant mantle cell lymphoma. Case 2: An 85 y/o male with COPD presented with weight loss and progressive dysphagia for 2 months. CT chest revealed a 2.5cm tracheal mass extending into the mediastinum, causing at least 50% narrowing of the trachea and consolidation of right middle lobe. On admission he developed acute respiratory failure from upper airway obstruction and was intubated. Bronchoscopy revealed a large polypoid tracheal mass found 5cm from the carina, causing 80% obstruction. The endobronchial component was removed using endoscopic electrosurgery. The histopathology was consistent with malignant large B cell follicular lymphoma. The patient was successfully extubated.

DISCUSSION: Primary tracheal malignancies make up less than 0.4% of all malignancies and extranodal non-hodgkins lymphoma arising in the trachea is responsible for less than 3% of all tracheal tumors.1 In histological classification of primary tracheal lymphoma, the more common types are lymphoblastic lymphoma and mucosa-associated lymphoid tissue lymphoma.2 The primary treatment modality for extranodal lymphoma is radiation, chemotherapy and palliative measures depending on the location of the tumor.1

CONCLUSIONS: Our cases demonstrate potentially fatal presentations of extranodal lymphomas involving the endotracheal region. Both successfully stabilized by endobronchial interventions.

Reference #1: Fideas et al.“Primary tracheal non-hodgkins lymphoma.” Cancer 77.11(1996):2332-38.

Reference #2: Kaplan et al.“Primary lymphoma of the trachea with morphologic and immunophenotypic characteristics of low grade B cell lymphoma of mucosa-associated lymphoid tissue.“Am J Surg Pathol 1992;16:71-5.

DISCLOSURE: The following authors have nothing to disclose: Audra Fuller, Ebtesam Islam, Raed Alalawi

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