Abstract

Introduction. Mantle cell lymphoma (MCL) comprises approximately 3% to 10% of all non-Hodgkin lymphomas. Although there is an increased risk for secondary malignancies after treatment among non-Hodgkin lymphomas survivors, a synchronous diagnosis of primary lung cancer arising in conjunction with lymphoma at the same site has rarely been reported. We report an unusual case of primary lung adenocarcinoma with coexistent MCL within the same lung lesion. Case Presentation. A 55-year-old female with newly diagnosed stage IV-B MCL was referred for workup of a right upper lobe cavitary lesion detected during lymphoma staging. A whole-body positron-emission tomography-computed tomography scan revealed diffuse adenopathy but also identified a cavitary right upper lobe lesion atypical for lymphoma. Bronchoscopy was unremarkable with cytology (on lavage) negative for malignancy. At 2 months, a computed tomography scan of the chest showed a persistent lesion. A video-assisted thoracoscopic wedge resection was performed. Histopathological examination revealed a lepidic predominant, well-differentiated adenocarcinoma (stage T1a) and foci of lymphoid infiltrate within and adjacent to the adenocarcinoma consistent with lung involvement by MCL. Discussion. Synchronous presentation of primary lung adenocarcinoma and lymphoma at a single site is exceedingly rare. Nonresolving pulmonary lesions with features atypical for lymphoma should be viewed with caution and worked up comprehensively to rule out occult second malignancies, in order to guide a prompt diagnosis and appropriate treatment.

Highlights

  • Mantle cell lymphoma (MCL) comprises approximately 3% to 10% of all non-Hodgkin lymphomas

  • We present the case of a middle-aged female diagnosed with MCL and primary pulmonary adenocarcinoma within the same nodule

  • A year later, she presented with dyspnea and a new right-sided pleural effusion

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Summary

Introduction

According to the World Health Organization classification of 2008,1 mantle cell lymphoma (MCL) is classified as a mature B-cell lymphoma, comprising about 6% of all adult non-Hodgkin’s lymphoma (NHL) in the United States. Prior to initiation of chemotherapy, she was referred to the pulmonary clinic for workup of the lung lesion, which was felt to have radiographic features atypical for lymphoma She was an active, 30 pack-year smoker with symptoms of stable chronic bronchitis, sinusitis, and scant hemoptysis. A year later, she presented with dyspnea and a new right-sided pleural effusion (cytology positive for adenocarcinoma, negative for epithelial growth factor receptor/anaplastic lymphoma kinase) She received 6 cycles of carboplatin/pemetrexed/bevacizumab with good treatment response; she declined further maintenance therapy due to an intolerance of side effects. A few months later (a year ago), she presented with weight loss, chills, and night sweats, and CT imaging showed progressive lymphadenopathy concerning for MCL She received ibrutinib and rituximab with good response initially; she could not complete the prescribed therapy due to side effects and was lost to follow-up at the time of this writing

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