Lymphocytic lymphoma recurring in multiple endobronchial sites.

A 64-year-old man was admitted to West Virginia University Hospital in July 1974 for evaluation of a left inguinal mass of three months' duration and a more recently enlarged right axillary mass. Biopsy at both sites showed diffuse poorly differentiated lymphocytic lymphoma. IHe was subjectively well and physical examination was otherwise normal. Laboratory data showed a haemoglobin of 15-0 grams, haematocrit of 43%, white blood cell count of 6200 with 41% lymphocytes, 2% eosinophils, 53% neutrophils, and 4% monocytes. Bone marrow aspirate and biopsy, multiphasic blood analysis, chest radiograph and liver/spleen scan were interpreted as normal. The patient was considered to have stage IIIA poorly differentiated lymphocytic lymphoma, and treatment was begun with vincristine, prednisone, and streptonigrin (Acute Leukaemia Group B Protocol for stage III and IV lymphoma). A complete clinical remission was achieved within two months. Maintenance therapy, consisting of intermittent cyclophosphamide, prednisone, and vincristine, was discontinued in September 1976 because there was no evidence of persisting disease. In March 1978 the patient developed enlargement of the left tonsil. Biopsy revealed recurrent lymphoma and chemotherapy with intermittent cyclophosphamide, prednisone, and vincristine was reinitiated without response. In July 1978 chemotherapy was stopped and radiotherapy to the left side of Waldeyer's ring was begun. The mass rapidly resolved. In August 1978 he developed a low grade fever, breathlessness, and a minimally productive cough. Physical examination revealed bilateral basal crackles