Endobronchial High-Grade Non-Hodgkin’s Lymphoma

To the Editor: Primary pulmonary lymphomas (PPLs) are uncommon and represent only 0.5% to 1% of all pulmonary neoplasms. They are defined as a clonal lymphoid proliferation in 1 or both lungs, parenchymal and/or endobrobronchial, with no extra-thoracic involvement at the time of diagnosis or during the following 3-month period. Regarding the thoracic disease, endobronchial involvement is even less common than parenchymal disease, appearing mainly as a part of systemic disease or contiguous with Hodgkin’s lymphoma.1,2 Here we report a rare case of a high-grade primary pulmonary, endobronchial nonHodgkin’s Lymphoma (NHL). A 72-year-old, life-long nonsmoker woman, presented with gradually worsening intermittent hemoptysis of 4 years’ duration. Her history was significant for hypertension, dyslipidemia, atrial fibrillation, and Graves’ disease, the latter treated with radioactive iodine. A computed tomography (CT) of the chest revealed segmental atelectasis involving lingula and a left hilar soft tissue mass (Fig. 1, white arrow). A flexible bronchoscopy revealed irregular submucosal infiltration involving the distal third of the left main bronchus. (Fig. 2) The histologic examination of the endobronchial biopsy was consistent with a high-grade diffuse NHL of large B-cell lymphoma (DLBCL) variety. The positron emission tomography (PETCT) study showed uptake only in the region of the left hilum. A bone marrow biopsy was unrevealing. The patient received 4 cycles of chemotheraphy with R-CHOP (Rituximab, Cyclophoshhamide, Doxorubicin, Vincristine, and Prednisona). At the time of this report, 6 months since the diagnosis, the disease remained under remission by CT and bronchoscopy. Primary pulmonary NHLs are rare, representing around 0.4% of all malignant lymphomas. Primary endobronchial involvement of the NHL is even more exceptional. Mucosaassociated lymphoid tissue (MALT) NHL is the most common histologic subtype involving the endobronchial tree. The patients are generally asymtomatic, with slow progression and late dissemination of the disease. The treatment may vary from a strict monitoring to surgery, radiotherapy, or chemotherapy. In contrast, aggressive NHLs are much less common and may appear as a result of a transformation of an asymtomatic lymphoma, posttransplant lymphoproliferative FIGURE 1. Atectasis in the lingual.