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• W2980562426 abstract "SESSION TITLE: Monday Fellow Case Report Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: A Pancoast tumour is an apical lung mass which involves structures of the apical chest wall. We present a case of a patient with an uncommon cause for a Pancoast tumour. CASE PRESENTATION: A 77 year old female was admitted for cough, breathlessness and fever of 5 days duration. She was a non-smoker and significant medical history included ischaemic heart disease. She was recently admitted 2 weeks prior for community acquired pneumonia with a chest radiograph which showed right apical nodular pleural thickening (Image 1). Physical examination revealed reduced breath sounds over the right hemithorax and palpable right supraclavicular lymphadenopathy. No clinical signs of Horner’s syndrome were noted. Serum biochemistry showed hypercalcaemia 3.29mmol/L, anaemia Hb 9.4g/dL and elevated lactate dehydrogenase (LDH) 432U/L. Chest radiograph showed right apical nodular pleural thickening and a new large right pleural effusion (Image 2). Computed tomography scan of the chest showed a right apical lung mass extending posteriorly to the right upper posterolateral chest wall with erosion into the surrounding bone, a right pleural effusion and mediastinal lymphadenopathy (Image 3). Thoracocentesis revealed a haemoserous, lymphocyte predominant pleural effusion with elevated LDH 526U/L and adenosine deaminase 58U/L. Fluid cytology showed large numbers of CD138+, CD79a+ plasma cells, mixed with CD20+, CD79a+, PAX5+ B lymphocytes. The plasma cells exhibited monoclonal kappa expression and were BCL2+, cyclin D1-, CD56, EBER-in-situ hybridization negative with a Ki-67 proliferation index of 45%. Flow cytometry showed atypical B cells which were CD19, CD20dim, CD38 positive. Bone marrow biopsy was negative for involvement. She was diagnosed with large B cell lymphoma and started on chemotherapy. DISCUSSION: The majority of Pancoast tumours are caused by a primary lung malignancy, with the most common histopathological subtype being squamous cell carcinoma (1). In our patient, initial impression was that of a metastatic primary lung Pancoast tumour and the diagnosis of lymphoma was only made on the basis of pleural fluid cytological analysis. Hematological malignancies such as primary pulmonary lymphoma (2) or plasma cell dyscrasias are uncommon causes of a lung mass that can mimic a primary lung malignancy with shared clinical features of hypercalcemia, pleural effusion, mediastinal lymphadenopathy and chest wall involvement. The main cause of effusions in patients with NHL is direct tumour infiltration of the pleura (3) while myeloma may present with a mass due to plasmacytoma. The presence of an effusion at diagnosis also portends a worse prognosis and thus patients are treated as having Stage IV disease. CONCLUSIONS: Hematological malignancies that primarily involve the lung can mimic primary lung cancer as they can present with shared features of hypercalcemia, chest wall involvement with pleural effusion. Reference #1: N Panagopoulos, et al. Pancoast tumors: characteristics and preoperative assessment. J Thorac Dis. 2014 Mar; 6(Suppl 1): S108–S115. Reference #2: Mian, M, et al. B cell lymphoma with lung involvement: what is it about? Acta Haematol. 2015;133(2):221-5. Reference #3: V.B. Antony, R. Loddenkemper, P. Astoul, C. Boutin, P. Goldstraw, J. Hott, F. Rodriguez Panadero, S.A. Sahn. Management of malignant pleural effusions. European Respiratory Journal Aug 2001, 18 (2) 402-419. DISCLOSURES: No relevant relationships by Si Yuan Chew, source=Web Response No relevant relationships by Nicole Sieow, source=Web Response No relevant relationships by Aza Taha, source=Web Response No relevant relationships by Anthony Yii, source=Web Response" @default.
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• W2980562426 date "2019-10-01" @default.
• W2980562426 modified "2023-09-25" @default.
• W2980562426 title "LYMPHOMA MIMICKING A PANCOAST LUNG CANCER" @default.
• W2980562426 doi "https://doi.org/10.1016/j.chest.2019.08.549" @default.
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