A rare tumoral combination, synchronous lung adenocarcinoma and mantle cell lymphoma of the pleura

Dimitrios Hatzibougias,Georgia Karayannopoulou,Christophoros N Foroulis,Mattheos Bobos,Georgios Karkavelas,Georgios T Karapanagiotidis,Ioannis Kostopoulos

doi:10.1186/1477-7819-6-137

Abstract

BackgroundCoexistence of adenocarcinoma and mantle cell lymphoma in the same or different anatomical sites is extremely rare. We present a case of incidental discovery of primary lung adenocarcinoma and mantle cell lymphoma involving the pleura, during an axillary thoracotomy performed for a benign condition.Case presentationA 73-year old male underwent bullectomy and apical pleurectomy for persistent pneumothorax. A bulla of the lung apex was resected en bloc with a scar-like lesion of the lung, which was located in proximity with the bulla origin, by a wide wedge resection. Histologic examination of the stripped-off parietal pleura and of the bullectomy specimen revealed the synchronous occurrence of two distinct neoplasms, a lymphoma infiltrating the pleura and a primary, early lung adenocarcinoma. Immunohistochemical and fluorescence in situ hybridization assays were performed. The morphologic, immunophenotypic and genetic findings supported the diagnosis of primary lung adenocarcinoma (papillary subtype) coexisting with a non-Hodgkin, B-cell lineage, mantle cell lymphoma involving both, visceral and parietal pleura and without mediastinal lymph node involvement. The neoplastic lymphoid cells showed the characteristic immunophenotype of mantle cell lymphoma and the translocation t(11;14). The patient received 6 cycles of chemotherapy, while pulmonary function tests precluded further pulmonary parenchyma resection (lobectomy) for his adenocarcinoma. The patient is alive and without clinical and radiological findings of local recurrence or distant relapse from both tumors 14 months later.ConclusionThis is the first reported case of a rare tumoral combination involving simultaneously lung and pleura, emphasizing at the incidental discovery of the two coexisting neoplasms during a procedure performed for a benign condition. Any tissue specimen resected during operations performed for non-tumoral conditions should be routinely sent for pathologic examination.

Highlights

Coexistence of adenocarcinoma and mantle cell lymphoma in the same or different anatomical sites is extremely rare
Recent epidemiologic evidence suggest that lung cancer is the leading cause of cancer mortality in both sexes and is distinguished according to histopathologic features in two large categories, the small cell lung carcinoma (SCLC) and the non-small cell lung carcinoma (NSCLC) [1]
Synchronous occurrence of lung adenocarcinoma and malignant lymphoma of the pleura is not reported until today and we report the unique case of a lung adenocarcinoma coexisting with a mantle cell lymphoma of the pleura, which were incidentally discovered during an operation for pneumothorax

Summary

Conclusion

The therapeutic management of such a combination of tumors requires separate consideration of their biologic behavior, the performance status of each patient individually and the estimated morbidity related to surgery and/ or chemo-radiotherapy. We should note that any tissue resected during any non-oncologic intrathoracic procedure should be collected separately and sent for pathologic examination, especially in older people. Any scar detected in the lung should resected during an intrathoracic procedure performed for benign disease, if do not require a major operation and do not add significant risk for the patient. Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal

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Discussion