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• W4387248944 abstract "SESSION TITLE: Airway Tumors SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/09/2023 02:10 pm - 02:55 pm INTRODUCTION: There are approximately 150000 new cases of Large B Cell Lymphoma (LBCL) annually representing nearly 30% of all non-Hodgkin's Lymphoma cases. Pulmonary involvement in LBCL is typically nodal, but other presentations have been described. We present a rare case of endobronchial LBCL. CASE PRESENTATION: A 67-year-old female with a past medical history of chronic obstructive pulmonary disease and hypertension presented with confusion and mechanical fall. Initially, the patient was afebrile, hypertensive, and hypoxic. Her hypoxia improved with supplemental oxygen via nasal canula. Primary lab results were positive for hypercalcemia (13.4 mg/dl), hypophosphatemia (2.2 mg/dl) and hypomagnesemia (1.2 mg/dl). The rest of her labs were within normal limits. Her radiographic evaluation included a CT head without IV contrast that was negative for any intracranial pathology. The CT of the cervical spine revealed an incidental finding of significant adenopathy present in the chest cavity that was further evaluated with CT angiography of the chest. This was negative for pulmonary embolism, however it depicted diffuse lymphadenopathy in the right peritracheal and subcarinal area (figure 2 and 3). Bronchoscopy with endobronchial ultrasound guided transbronchial fine needle aspiration (EBUS-TBNA) was performed to assess extensive lymphadenopathy with proximity to the airway.This procedure revealed a friable non-obstructive endobronchial lesion in the main carina (figure 1), involving the medial walls of right and left mainstem bronchi. Endobronchial biopsies via forceps were taken followed by lymph node sampling. Tissue pathology resulted in diffuse large B cell lymphoma. Cytology from the subcarinal and right lower paratracheal lymph node stations revealed a similar diagnosis of diffuse large B cell lymphoma. DISCUSSION: Endobronchial lymphoma is categorized into two classes based off the pattern of involvement of lymphoma. Type I endobronchial lymphoma is found in systemic lymphoma and is characterized as diffuse submucosal lymphoma developing from hematogenous or lymphangitic spread. Type II includes airway involvement of lymphoma due to lymphoma originating from bronchus associated lymphoid tissue (BALT) or from direct spread of lymphoma from adjacent lymph nodes. Type II lesions tend to be associated with symptoms of airway obstruction including cough, wheezing, and hemoptysis. Diagnosis of endobronchial lymphoma secondary to PPL requires endoscopic findings of an endobronchial tumor, histological evidence of lymphoma from tissue biopsy, and absence of extra-thoracic lymphoma. LBCL is typically treated with systemic chemotherapy along with Rituximab. In patients with endobronchial lesions greater than 10 cm in diameter, adjuvant radiation and surgical resection can be utilized as therapeutic options (4).Non-Hodgkin's Lymphoma (NHL) is a rare presentation for primary pulmonary lymphoma (PPL) accounting for less than 3-4% of all extra-nodal NHL cases and 0.5 – 1% of all primary pulmonary malignancies (4,5). Where PPL is described in the literature, it is usually found to be of the mucosa-associated lymphoma tissue (MALT) type. LBCL is less common accounting for approximately 20-25% of PPL (6). CONCLUSIONS: Although PPL is considered rare, it should be considered in the differential diagnosis when evaluating the airway and associated lymphadenopathy. This case highlights importance of adequate and comprehensive tissue sampling. REFERENCE #1: 1) Önür, S. T., Dalar, L., & Sökücü, S. N. (2014). Primary Tracheal B-cell Lymphoma. Causing Recurrent Central Airway Obstruction. Archivos De Bronconeumologia. https://doi.org/10.1016/j.arbr.2014.06.019 REFERENCE #2: 2) Yang, F., Gao, R., Miao, Y., Yan, X., Hou, G., Li, Y., Wang, Q., & Kang, J. (2015). Primary tracheobronchial non-Hodgkin lymphoma causing life-threatening airway obstruction: a case report. Journal of Thoracic Disease, 7(12), E667-71. https://doi.org/10.3978/j.issn.2072-1439.2015.12.05 REFERENCE #3: 3) Keino, D., Sudo, A., Mizuno, M., Sasaki, K., Kinoshita, A., & Mori, T. (2021). Diffuse Large B-Cell Lymphoma of the Trachea in a Child With Symptoms of Bronchial Asthma. Journal of Pediatric Hematology Oncology. https://doi.org/10.1097/mph.00000000000018174) Solomonov, Anna, et al. Non‐Hodgkin's lymphoma presenting as an endobronchial tumor: report of eight cases and literature review. American journal of hematology 83.5 (2008): 416-419.5) Cadranel, Jacques, M. Wislez, and M. Antoine. Primary pulmonary lymphoma. European Respiratory Journal 20.3 (2002): 750-762.6) Ferraro, Pasquale, et al. Primary non-Hodgkin's lymphoma of the lung. The Annals of thoracic surgery 69.4 (2000): 993-997. DISCLOSURES: No relevant relationships by Maria Abril No relevant relationships by Julieta Osella No relevant relationships by Subhan Toor" @default.
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• W4387248944 date "2023-10-01" @default.
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• W4387248944 title "A RARE CASE OF ENDOBRONCHIAL LARGE B CELL LYMPHOMA" @default.
• W4387248944 doi "https://doi.org/10.1016/j.chest.2023.07.2787" @default.
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