Pulmonary Manifestations of Systemic Disease: Student/Resident Case Report Poster - Pulmonary Manifestations of Systemic Disease II |

Cannon Ball Metastases: A Rare Pulmonary Manifestation of Diffuse Large B-Cell Lymphoma FREE TO VIEW

Mangalore Amith Shenoy, MBBS; Pavan Gorukanti, MBBS; Pavan Irukulla, MBBS; Amit Agarwal, MBBS; Amogh Gajankush, MBBS; Animesh Gour, MBBS; Kabu Chawla, MD; William Pascal, MBBS
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Maimonides Medical Center, Brooklyn, NY

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

Chest. 2016;150(4_S):1107A. doi:10.1016/j.chest.2016.08.1214
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SESSION TITLE: Student/Resident Case Report Poster - Pulmonary Manifestations of Systemic Disease II

SESSION TYPE: Student/Resident Case Report Poster

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

INTRODUCTION: Diffuse large B-cell lymphoma (DLBCL) is an aggressive form of Non- Hodgkin’s Lymphoma. In stage IV of the disease, widespread involvement of organs other than lymph nodes is seen. We present a rare case of stage IV DLBCL with cannon ball metastases in the lungs.

CASE PRESENTATION: A 72 years old man with history of treated prostate cancer and Stage IV DLBCL who had completed R-CHOP regimen of chemotherapy presented with back pain and worsening mental status. His lymphoma was diagnosed a year prior with a liver biopsy. He was found to have low-grade fever and lethargy on presentation. He was started on empiric broad-spectrum antibiotics for possible sepsis. During the work up for his fever, his chest x-ray showed innumerable bilateral pulmonary nodules, which were absent in the chest x-ray done 4 months back. A CT scan of the chest was done which showed multiple pulmonary masses resembling cannon balls. In view of patient’s history of prostate cancer and immune-compromised status and possible infection, decision was made to biopsy the lung lesion. CT guided needle biopsy of the lung lesion was done, histopathology of which was consistent with DLBCL. He was given combination chemotherapy of rituximab, gemcitabine and oxaliplatin. His clinical condition subsequently worsened and he expired.

DISCUSSION: DLBCL in advanced stages is known to involve the lungs. Lung involvement although rare can manifest as; nodules, diffuse ground-glass opacity, cavitary and endobronchial lesions (1,2). Large rounded well-circumscribed metastatic pulmonary nodules are called ‘Cannon ball’ metastases, mostly seen in renal cell carcinoma, prostate cancer and choriocarcinoma (3). Although very rare, this case emphasizes the need to consider advanced DLBCL in the differential for cannon ball metastases.

CONCLUSIONS: DLBCL is a rare cause of cannon ball metastases.

Reference #1: Fishbein, M., T. Wang, and J. Albores. “Pulmonary Diffuse Large B Cell Lymphoma Presenting As Chronic Cough.” Am J Respir Crit Care Med 187 (2013): A6138.

Reference #2: Kondapaneni, M., et al. “Pulmonary Involvement By Diffuse Large B Cell Lymphoma.” Am J Respir Crit Care Med 183 (2011): A3845.

Reference #3: Ammannagari, Nischala, and Vengamamba Polu. “‘Cannon ball’pulmonary metastases.” BMJ case reports 2013 (2013): bcr2012008158.

DISCLOSURE: The following authors have nothing to disclose: Mangalore Amith Shenoy, Pavan Gorukanti, Pavan Irukulla, Amit Agarwal, Amogh Gajankush, Animesh Gour, Kabu Chawla, William Pascal

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