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Synchronous BALT Lymphoma and Primary Adenocarcinoma Presenting as Pneumonia
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A4058 - Synchronous BALT Lymphoma and Primary Adenocarcinoma Presenting as Pneumonia
Author Block: P. Stetsyuk1, M. A. Jacob2, C. R. Galvez-Padilla1, T. R. Chandak2; 1Department of Surgery, Berkshire Medical Center, Pittsfield, MA, United States, 2Department of Medicine, Berkshire Medical Center, Pittsfield, MA, United States.
Introduction: Bronchial-associated lymphoid tissue (BALT) lymphoma is a rare type of lymphoma incidentally found in patients without respiratory symptoms. Appearance on imaging is variable, and not always associated with lymphadenopathy, with only 30% of associated nodal specimens being diagnostic. The unusual presentation of BALT, in synchrony with a resectable primary adenocarcinoma of the lung, promotes the importance of a complete workup and screening especially in smokers. Description: Our patient is a fifty-one year-old female, with history of smoking and COPD, who presented with recurrent pneumonia. Lung imaging showed persistent bilateral infiltrates and solid tissue lesions. A lung biopsy showed interstitial lymphoid aggregates with mixed B and T cells. Positron emission tomography (PET) showed hyper-metabolic uptake in both lungs. Flow cytometric analysis was negative. Bone marrow biopsy showed no evidence of lymphoma. However, a video-assisted thoracoscopic surgery (VATS) wedge biopsy showed extra-nodal tissue aggregates consistent with marginal zone BALT lymphoma with negative margins. Post-procedural serial follow up with CT showed persistent lesions, with repeat PET demonstrating increased activity. Subsequent VATS resection demonstrated poorly differentiated adenocarcinoma, a T1aN0 lesion resected with negative margins and three negative lymph node stations. Discussion: While low grade proliferative BALT lymphoma has been reported to be successfully treated with chemotherapeutic agents, BALT has a good prognosis and a higher 5-year survival rate especially after surgical resection. Additionally, extra-nodal localization of BALT lymphoma may evade initial diagnosis by CT guided percutaneous biopsy. The rare presentation of a synchronous BALT and adenocarcinoma of the lung poses the concern over association with smoking, which may have an important association with tumor genesis of synchronous lesions. While current approaches to the diagnosis and management of this rare lymphoma as successful, further collaborative prospective trials are lacking.
Author Block: P. Stetsyuk1, M. A. Jacob2, C. R. Galvez-Padilla1, T. R. Chandak2; 1Department of Surgery, Berkshire Medical Center, Pittsfield, MA, United States, 2Department of Medicine, Berkshire Medical Center, Pittsfield, MA, United States.
Introduction: Bronchial-associated lymphoid tissue (BALT) lymphoma is a rare type of lymphoma incidentally found in patients without respiratory symptoms. Appearance on imaging is variable, and not always associated with lymphadenopathy, with only 30% of associated nodal specimens being diagnostic. The unusual presentation of BALT, in synchrony with a resectable primary adenocarcinoma of the lung, promotes the importance of a complete workup and screening especially in smokers. Description: Our patient is a fifty-one year-old female, with history of smoking and COPD, who presented with recurrent pneumonia. Lung imaging showed persistent bilateral infiltrates and solid tissue lesions. A lung biopsy showed interstitial lymphoid aggregates with mixed B and T cells. Positron emission tomography (PET) showed hyper-metabolic uptake in both lungs. Flow cytometric analysis was negative. Bone marrow biopsy showed no evidence of lymphoma. However, a video-assisted thoracoscopic surgery (VATS) wedge biopsy showed extra-nodal tissue aggregates consistent with marginal zone BALT lymphoma with negative margins. Post-procedural serial follow up with CT showed persistent lesions, with repeat PET demonstrating increased activity. Subsequent VATS resection demonstrated poorly differentiated adenocarcinoma, a T1aN0 lesion resected with negative margins and three negative lymph node stations. Discussion: While low grade proliferative BALT lymphoma has been reported to be successfully treated with chemotherapeutic agents, BALT has a good prognosis and a higher 5-year survival rate especially after surgical resection. Additionally, extra-nodal localization of BALT lymphoma may evade initial diagnosis by CT guided percutaneous biopsy. The rare presentation of a synchronous BALT and adenocarcinoma of the lung poses the concern over association with smoking, which may have an important association with tumor genesis of synchronous lesions. While current approaches to the diagnosis and management of this rare lymphoma as successful, further collaborative prospective trials are lacking.
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