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A4063 - A Case Report of Primary Pulmonary Mucosa Associated Lymphoid Tissue Lymphoma
Author Block: A. Magge, O. Ibrahim; Pulmonary and Critical Care Medicine, University of Connecticut, Farmington, CT, United States.
Primary pulmonary lymphoma (PPL) is an extremely rare form of lung cancer and accounts for less than one percent of all primary malignant lung cancers and of all lymphomas. The most common types of pulmonary lymphoma include mucosa-associated lymphoid tissue (MALT), diffuse large B-cell lymphoma, and aplastic large cell lymphoma. MALT lymphomas are the most common amongst PPLs and they often have an indolent course. In this case report we present an elderly female presenting with shortness of breath found to have an incidental finding on imaging, which was found to be MALT. An 85 year-old female with thyroid cancer status post thyroidectomy presented to the hospital for shortness of breath and hypertensive urgency. Her hospital course was initially complicated by pulmonary edema, which improved with diuresis, and a pericardial effusion, which was assessed by transthoracic echocardiogram, and deemed stable. Patient’s shortness of breath resolved, however a chest x-ray revealed a left lung mass. A computed tomography (CT) scan revealed a 2.9 by 3.1 centimeters (cm) lobular mass within the left lower lobe with no appreciable lymphadenopathy concerning for malignancy. Pulmonary was consulted and after a discussion with the patient and her family, she underwent an endobronchial ultrasound and a navigational bronchoscopy. Initial cytology obtained was non-diagnostic. Therefore, she underwent a CT-guided core biopsy which revealed an atypical lymphoplasmacytic infiltrate consistent with MALT lymphoma, a low-grade B-cell lymphoproliferative disorder. Repeat CT scan revealed an interval decrease in the size of the previously seen left lower lobe lung lesion without intervention. Patients with MALT lymphomas are often asymptomatic at the time of diagnosis. The most frequent symptoms patients may have include dyspnea, fevers, sweats, and weight loss. Given that MALT lymphomas often have an indolent course, asymptomatic patients may be better candidates for surveillance rather than aggressive therapy. When symptoms are present, there are chemotherapy options for these patients, however age and performance status must be considered given these have been shown to be adverse prognostic factors. A chlorambucil-based chemotherapy with or without immunotherapy should be administered as the initial choice. The overall survival rate of patients with MALT lymphoma is approximately 85-95% at five years and about 90% at ten years. Primary MALT lymphomas although being rare has a good prognosis, with a high 5-year survival rate. Given that there are no current guidelines on treatment of MALT lymphomas most physicians monitor progression of disease rather than immediately initiating chemotherapy.