Primary pulmonary MALT lymphoma can present with unique airway involvement, such as a solitary mass or diffuse polypoidal lesions, underscoring the importance of bronchoscopy for timely diagnosis.
Case Report (n=2)
Pulmonary MALT lymphoma can present with non-specific obstructive airway symptoms, highlighting the importance of bronchoscopy and advanced imaging for timely diagnosis.
Abstract Introduction Pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma is exceedingly rare and frequently masquerades as obstructive lung disease till work up with imaging or bronchoscopy is performed. Clinical presentation ranges from no symptoms to cough, dyspnea, chest pain or hemoptysis 1. Due to non-specific symptoms, diagnosis is often missed until patients become more symptomatic and warrant bronchoscopy. We present two cases of primary pulmonary MALT lymphoma; presenting with unique airway involvement which were diagnosed via endobronchial biopsy. Case Reports Our first patient (A) is a 54-year-old-male with prior history of stage II colorectal cancer in remission who presented with progressive dyspnea and cough over several months. His surveillance PET imaging was concerning for an endotracheal mass obstructing the airway without associated adenopathy. A bronchoscopic evaluation of the mass showed a large solitary mass causing 90% occlusion of proximal trachea with pathology consistent with MALT lymphoma. He underwent bronchoscopic tumor ablation followed by definitive radiation therapy.Our second patient (B) is an 84-year-old female with history of hypertension and common-variable immune deficiency (CVID) who had been experiencing intermittent shortness of breath, generalized facial swelling and stridor for years. She was treated with short courses of corticosteroids with each presentation to different hospitals, which improved her symptoms. Her chest CT was concerning for central airway obstruction as well as generalized lymphadenopathy. A bronchoscopic exam was performed and showed diffuse airway involvement with multiple polypoidal lesions throughout her central airways Figure 1. Pathology of the endobronchial biopsy of one of the lesions showed involvement with MALT lymphoma. She was started on treatment with Rituxan. Discussion Pulmonary MALT lymphoma is a rare tumor which presents with non-specific symptoms of obstructive airway disorder. Pulmonary MALT lymphoma can be associated with chronic inflammation such as in autoimmune disorders, as opposed to MALT in other organs that are often associated with infection 23. We highlight the various bronchoscopic presentations of this tumor, which can present as a solitary tumor in the airway or with diffuse mucosal involvement. These cases underscore the significance of advanced chest imaging and direct visual inspection with bronchoscopy in patients who present with recurrent non-specific symptoms of airway obstruction. Given good prognosis of pulmonary MALTomas 1, timely diagnosis and initiation of therapy can result in improved clinical outcomes. This abstract is funded by: None
Yazdi et al. (Fri,) conducted a case report in Pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma (n=2). Bronchoscopy and endobronchial biopsy was evaluated. Primary pulmonary MALT lymphoma can present with unique airway involvement, such as a solitary mass or diffuse polypoidal lesions, underscoring the importance of bronchoscopy for timely diagnosis.