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Journal of Thoracic Oncology:
doi: 10.1097/JTO.0b013e31816e23cf
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B-Cell Non-Hodgkin Lymphoma Presenting As an Endobronchial Polypoid Mass

Kaira, Kyoichi MD, PhD; Ishizuka, Takahiro MD, PhD; Tanaka, Hiroto MD; Tanaka, Yoshiki MD; Ishizuka, Tamotsu MD, PhD; Yanagitani, Noriko MD, PhD; Sunaga, Noriaki MD, PhD; Hisada, Takeshi MD, PhD; Mori, Masatomo MD, PhD

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Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Shouwa-machi, Maebashi, Gunma, Japan.

Disclosure: The authors declare no conflict of interest.

Address for correspondence: Kyoichi Kaira, MD, PhD, Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Shouwa-machi, Maebashi, Gunma 371-8511, Japan. E-mail: kkaira1970@yahoo.co.jp

A 63-year-old man presented with hemoptysis. There was no history of night sweat or fever. The skin was normal and there was no peripheral lymphadenopathy. A chest radiograph was unremarkable. A computed tomography of the chest revealed a polypoid mass arising from the carina (Figure 1). The polypoid mass alone was confirmed on positron emission tomography with fluorine-18-labeled fluorodeoxyglucose scanning (Figure 2). Flexible bronchoscopy revealed a 25-mm, polypoid beefy mass arising from the carina (Figure 3). Biopsies confirmed a non-Hodgkin lymphoma of B cell origin. There was no evidence of lymphoma involvement in any other site. He received three cycles of combination chemotherapy (R-CHOP regimen), followed by radiation therapy in the area of the carina. He responded rapidly and restaging work-up revealed that the polypoid mass disappeared completely. He was doing well at 6 months after tumor diagnosis.

Figure 1
Figure 1
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Figure 2
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Figure 3
Figure 3
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Malignant lymphoma arising from the endobronchial lesions is extremely rare. We are not aware of non-Hodgkin lymphoma presenting as an endobronchial polypoid mass arising from the carina. The endobronchial involvement of malignant lymphoma is likely to arise in a bronchus-associated lymphoid tissue.1 Another possible mechanism is directed bronchial invasion and lymphatic spread, because bronchi have a rich supply of perivascular and peribronchial lymphatics.2 In this case, the diagnosis may be delayed if the patient has no complaint of any symptoms. Direct bronchoscopy and biopsy is the definite investigation. Primary lymphoma arising form the carina is a chemosensitive tumor, and it is necessary to add primary lymphoma to the list of causes of endobronchial polypoid masses.

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REFERENCES

1. Bienenstock J, Johnston N, Perey DYE. Bronchial lymphoid tissue. Lab Invest 1973;28:686–698.

2. Hardy K, Nicholson DP, Schaefer RF, et al. Bilateral endobronchial non-Hodgkin’s lymphoma. South Med J 1995;88:367–370.

Cited By:

This article has been cited 1 time(s).

Journal of Clinical Oncology
Anaplastic large-cell lymphoma presenting as an endobronchial polypoid tumor
Chen, SC; Shih, CM; Su, JL; Yeh, SP; Chen, CH; Tseng, GC; Hsu, WH; Cheng, WE; Lin, YS; Tsai, YL
Journal of Clinical Oncology, 26(): 4845-4847.
10.1200/JCO.2008.18.4325
CrossRef
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Keywords:

Non-Hodgkin lymphoma; Endobronchial polypoid mass; Carina; Lung

© 2008International Association for the Study of Lung Cancer

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