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• W4387248914 abstract "SESSION TITLE: Diffuse Lung Disease Case Report Posters 9 SESSION TYPE: Case Report Posters PRESENTED ON: 10/09/2023 02:10 pm - 02:55 pm INTRODUCTION: Cystic lung disease (CLD) is characterized by the presence of multiple thin walled, low-attenuating areas of air filled spaces (1). There are multiple causes of CLD, of which amyloidosis is an uncommon but clinically relevant condition. Marginal zone lymphoma is a rare primary lung malignancy that can be associated with pulmonary amyloidosis (2). CASE PRESENTATION: This is an 82-year-old former registered nurse in a tuberculosis (TB) ward with a significant history of left upper lobe marginal zone lymphoma who presented with dyspnea and productive cough with green sputum. Patient had no other history of pulmonary disease, with the exception of a recent COVID-19 infection. On presentation, a computed tomography (CT) chest was performed showing large bullous disease and a moderate left sided pleural effusion (Figures 1 and 2). Patient underwent thoracentesis which drained 1300cc of serosanguinous fluid, which was consistent with a lymphocytic predominant exudative pleural effusion. With her occupational history and pleural fluid analysis, she was isolated and had three sputum samples obtained, which resulted negative for acid-fast bacilli. She subsequently underwent a bronchoscopy with bronchoalveolar lavage which was negative for TB and malignancy, but did show staphylococcal species, for which she was started on antibiotics. Patient was then referred to cardiothoracic surgery for video-assisted thoracic surgery (VATS). During the VATS procedure, about 500cc of serosanguineous fluid was evacuated from the left chest. The lung and pleura were noted to be inflamed, pleura was biopsied. Lung tissue was noted to have large blebs and cystic disease, which were not biopsied to avoid causing significant air leak. Left pleural biopsy resulted positive for low-grade B cell lymphoma. Pathology is pending Congo red staining to evaluate for amyloidosis. DISCUSSION: Pulmonary cysts can be seen in normal individuals, but can be associated with multiple underlying lung diseases. Cystic lung disease can be seen in neoplastic, congenital, lymphoproliferative, and infectious cases, and can also be associated with smoking (3). When assessing a patient with cystic lung disease, it is important to take medical history, occupational exposure, and social history into account.Cases have been reported showing primary pulmonary amyloidosis as a rare complication of marginal zone lymphoma. Bullous lung disease from amyloidosis may be progressive and severe (2). Given this patient's medical history, it is important to consider amyloidosis in the differential for cystic lung disease. The diagnosis of primary pulmonary lymphoma relies on tissue biopsy and immunohistochemical staining (2). Biopsies stained with Congo red will show the typical apple-green birefringence on the fibrillary deposits in the lung (2). Once the diagnosis of pulmonary amyloidosis is made, it is important to evaluate these patients for systemic amyloidosis. CONCLUSIONS: When evaluating a patient with cystic lung disease, it is important to consider all differentials, especially those most clinically relevant to the patient's medical, occupational, and social history. REFERENCE #1: Raoof S, Bondalapati P, Vydyula R, Ryu JH, Gupta N, Raoof S, Galvin J, Rosen MJ, Lynch D, Travis W, Mehta S, Lazzaro R, Naidich D. Cystic Lung Diseases: Algorithmic Approach. Chest. 2016 Oct;150(4):945-965. doi: 10.1016/j.chest.2016.04.026. Epub 2016 May 13. PMID: 27180915; PMCID: PMC7534033. REFERENCE #2: King, C. S., Holley, A. B., & Sherner, J. H. (2008). Severe bullous lung disease due to marginal-zone-lymphoma-associated amyloidosis. Respiratory care, 53(11), 1495–1498. REFERENCE #3: Gupta N, Vassallo R, Wikenheiser-Brokamp KA, McCormack FX. Diffuse Cystic Lung Disease. Part I. Am J Respir Crit Care Med. 2015 Jun 15;191(12):1354-66. doi: 10.1164/rccm.201411-2094CI. PMID: 25906089; PMCID: PMC5442966. DISCLOSURES: No relevant relationships by Nourhan Kika No relevant relationships by Mary Lockwood No relevant relationships by Nisha Patel No relevant relationships by Anthony Saleh No relevant relationships by Gurinder Sunner" @default.
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• W4387248914 date "2023-10-01" @default.
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• W4387248914 title "MARGINAL ZONE LYMPHOMA-ASSOCIATED CYSTIC LUNG DISEASE" @default.
• W4387248914 doi "https://doi.org/10.1016/j.chest.2023.07.2203" @default.
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