A Case of Bronchus-Associated Lymphoid Tissue Lymphoma Diagnosed by Navigational Bronchoscopy

Abstract

SESSION TITLE: Bronchoscopy and Associated Procedures SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 31, 2017 at 01:30 PM - 02:30 PM INTRODUCTION: Bronchus-associated lymphoid tissue (BALT) lymphomas of the lung are uncommon and diagnosis is often delayed due to indolent clinical course, varied radiographic presentations, inability to obtain adequate sampling by bronchoscopy and eventual need for surgical biopsy. To date, there have been no cases of BALT lymphoma diagnosed by navigational bronchoscopy. We describe the first case, to our knowledge, of BALT lymphoma diagnosed by navigational bronchoscopy. CASE PRESENTATION: A 77 year-old female with a 25 pack-year history of smoking was referred to our Pulmonary clinic after incidental finding of a nodule on computed tomography (CT) of the chest performed at an outside hospital for chest pain. The CT Chest demonstrated a 1.6 cm ground-glass nodule in the left upper lobe. There were no prior CTs for comparison. Due to concern for malignancy, we proceeded with flexible bronchoscopy with transbronchial biopsy but pathology did not yield malignant cells. Given continued concern for malignancy, various options to obtain tissue diagnosis were considered. She was felt to be a poor candidate for CT-guided core biopsy which would likely result in pneumothorax due to diffuse emphysematous changes on CT. She was also not an optimal candidate for surgical biopsy due to severely reduced forced expiratory volume in one second (FEV1). Therefore, attempt at sampling was made by navigational bronchoscopy. Biopsy results yielded histology consistent with marginal zone lymphoma of bronchial associated lymphoid tissue. Since bronchoscopy, the patient has been managed conservatively with serial CT scans due to lack of constitutional symptoms that would necessitate treatment for lymphoma. DISCUSSION: Marginal zone lymphomas of the lung, also known as BALT lymphomas, arise from BALT which are not native to the bronchial tree. BALT is hypothesized to form in response to various antigenic stimuli, such as smoking, inflammatory disorders or autoimmune diseases. BALT lymphomas account for only .5% of all pulmonary malignancies1; most require no treatment due to indolent course. BALToma can be diagnosed by bronchoscopy; however, surgical lung biopsy is often required for optimal histologic yield. The most appropriate biopsy technique can be a challenging clinical risk-benefit decision and peripheral location of lesions in addition to patient co-morbidities including emphysematous changes around the lesion, respiratory function, and the likelihood of malignancy must be taken into account. Since BALT lymphomas frequently have indolent courses, the risks associated with a more aggressive diagnostic modality such as surgical biopsy may not be justifiable. CONCLUSIONS: In using navigational bronchoscopy, we were able to avoid the risks associated with both surgical biopsy and CT-guided biopsy to obtain a diagnosis of BALT lymphoma of the lung. Reference #1: Stefanovic, A et al. Pulmonary marginal zone lymphoma. Leukemia and Lymphoma. 2008 Jul;49(7):1311-20. DISCLOSURE: The following authors have nothing to disclose: Tasnim Lat, Parsa Hodjat, Juan Sanchez, Carl Boethel No Product/Research Disclosure Information