1. Non Hodgkin’s Lymphoma presenting as an endobronchial tumour
Shahul Hameed Aboobackar1,  Manu Mohan K2, Aswini Kumar Mohapatra3
1 Post graduate student, 2 Associate Professor, 3 Professor,
Department of Pulmonary Medicine, Kasturba Medical College Manipal, Manipal University, Manipal, Karnataka, India
Abstract
Figure 2
Non-Hodgkin’s lymphoma (NHL) involves the thorax in about 40 to 50% of cases. Mediastinal lymph node involvement is the most common thoracic abnormality in patients with NHL.  Extranodal manifestations include lung parenchymal involvement, pleural effusion, pericardial effusion and chest wall involvement. NHL involving the bronchial tree is uncommon, and the initial presentation of NHL as an endobronchial tumor is extremely rare.
Introduction
Non-Hodgkin’s lymphoma refers to a diverse group of neoplasm, accounting for about 3% of malignancies in adults. The thorax is involved in about 40 to 50% of cases with NHL. Mediastinal lymphadenopathy accounts for the most common thoracic manifestation in NHL patients. However, lymphomatous involvement of airways is rarely encountered. Here, we present a case of disseminated Non Hodgkin’s lymphoma presenting primarily as an endobronchial tumor in a patient with treated auto immune hemolytic anemia.
Figure 3
History
44-year-old male
Clerical staff
Dry cough and exertional breathlessness since 1 month.
No history of chest pain, hemoptysis or constitutional symptoms.
Diagnosed with autoimmune haemolytic anaemia 6 yrs back - resolved after taking long term steroids.
No history of pulmonary tuberculosis in the past.
Non smoker.
Outcome
Treated with chemotherapy including six cycles of cyclophosphamide, vincristine, adriamycin and prednisolone (CHOP regimen).
Improved with chemotherapy.
Asymptomatic at follow up.
Complete resolution of lesions in follow up PET scan.
Physical examination
No pallor, clubbing, lymphadenopathy or neck swellings.
Respiratory system examination - monophonic rhonchi over the right infrascapular and infraaxillary areas.
Examination of other systems - within normal limits.
Discussion
Investigations
Non-Hodgkin’s lymphoma refers to a diverse group of neoplasm, which account for about 3% of all malignancies in adults.
Non-Hodgkin’s lymphoma (NHL) involves the thorax in about 40 to 50% of cases.
Mediastinal lymphadenopathy accounts for the most common thoracic manifestation in NHL patients.
Lung involvement may appear as discrete nodules or masses, air-space consolidation, infiltrations contiguous with enlarged lymph nodes or masses, or interstitial thickening resembling lymphangitic spread of carcinoma.
n some patients lung infiltration may be rapid, mimicking pneumonia.
Bronchial narrowing or obstruction may occur because of compression by hilar mass.
NHL involving the bronchial tree is uncommon, and the initial presentation of NHL as an endobronchial tumor is extremely rare.
It is not possible to radiologically differentiate NHL from other malignancies.
Differentiation of lymphomas from other malignancies is possible by histopathology coupled with immunohistochemical studies.
Chemotherapy is the treatment of choice.
Approximately 40-50% of these patients are cured with standard chemotherapy.
Approximately 35-40% will respond but ultimately progress or relapse.
The remainder has disease that is refractory to primary treatment. 
Routine blood investigations were normal.
Chest radiograph revealed a right paracardiac mass with right lower zone opacification [Figure 1].
CECT thorax revealed a well defined heterogeneously enhancing lesion in the mediastinum, causing abrupt cut off of the right lower lobar bronchus, leading to collapse of the basal segments of right lower lobe along with mild right sided pleural effusion [Figure 2].
Fiberoptic bronchoscopy revealed an endobronchial mass (Figure 3) occluding the right middle lobe and lower lobe bronchi. [Figure 3].
Figure 1
References
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