CHRONIC PARENCHYMAL INFILTRATION FROM MALT LYMPHOMA: DIAGNOSIS BY ENDOBRONCHIAL ULTRASOUND

Abstract

SESSION TITLE: Lung Pathology 2 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Mucosa-associated lymphoid tissue (MALT) lymphoma is a rare cause of pulmonary infiltrate. The lung accounts for only 4% of all extra-nodal marginal zone MALT lymphomas [1] and presents mostly as an incidental finding or with non-specific symptoms. CASE PRESENTATION: A previously healthy 59-year-old man presented with chest pain in 2013. A chest radiograph noted bilateral infrahiliar masses. Computed tomography (CT) of the chest showed bilateral lung consolidations (Figure 1). He was treated with antibiotics and lost to follow up. Five years later the patient presented with transient stroke-like symptoms and a chest x-ray showed a persistent infiltrate. CT chest noted large bibasilar consolidations with air bronchograms and dilated bronchi (Figure 2). These infiltrates were hypermetabolic on positron emission tomography (PET) with a maximum standardized uptake value (SUV) of 6.4. The patient underwent bronchoscopy with endobronchial ultrasound guided transbronchial 19 gauge needle aspiration (EBUS-TBNA) of the consolidative lesions. Immunohistochemistry and flow cytometry confirmed a diagnosis of MALT lymphoma. He was referred to oncology and initiated on rituximab and bendamustine. DISCUSSION: MALT lymphoma of the lung is a relatively rare disease that has been associated with chronic antigen stimulation in the context of infection, autoimmune disease and toxic exposure. The clinical presentation and radiographic findings are varied and can be mistaken for more common entities. Lesions are usually bilateral and often have associated air bronchograms and bronchiectasis [2]. The disease usually has an indolent course with a favorable prognosis. In most reported cases, diagnosis was achieved with open lung or CT-guided biopsy. The role of EBUS-TBNA for pulmonary MALT lymphoma has been previously described in mediastinal lymphadenopathy and was found to be useful [3]. To our knowledge, this is the first case of EBUS-TBNA of lung infiltrates to diagnose this condition. CONCLUSIONS: MALT lymphoma is a rare lung malignancy that should be considered in the differential diagnosis of non-resolving pulmonary lesions. Minimally invasive approaches such as bronchoscopy and EBUS-TBNA can retrieve sufficient tissue for diagnosis. Reference #1: Schreuder MI, Van den Brand M, Hebeda K, et al. Novel developments in the pathogenesis and diagnosis of extranodal marginal zone lymphoma. J Hemathopatol. 2017; 10: 91-107. Reference #2: Wislez M, Cadranel J, Antoine M, et al. Lymphoma of pulmonary mucosa-associated lymphoid tissue: CT scan findings and pathological correlations. Eur Respir J. 1999; 14: 423-429. Reference #3: Nunez AL, Jhala NC, Carroll AJ, et al. Endoscopic ultrasound and endobronchial ultrasound-guided fine-needle aspiration of deep-seated lymphadenopathy: Analysis of 1338 cases. Cytojournal. 2012;9:14. DISCLOSURES: Consultant relationship with Boston Scientific Please note: $1-$1000 Added 03/02/2018 by Alex Chee, source=Web Response, value=Consulting fee No relevant relationships by Isabel Londono Marulanda, source=Web Response Consultant relationship with Boston Scientific Please note: $5001 - $20000 Added 03/04/2018 by Adnan Majid, source=Web Response, value=Consulting fee Consultant relationship with Olympus Please note: $5001 - $20000 Added 03/04/2018 by Adnan Majid, source=Web Response, value=Consulting fee No relevant relationships by Mihir Parikh, source=Web Response No relevant relationships by Andrew Schissler, source=Web Response