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B cell non-Hodgkin’s lymphoma of the trachea mimicking COPD

V Johnson, N J Burrows, N J Ali, G Cox

Department of Respiratory Medicine, Sherwood Forest Hospitals NHS Trust, Nottinghamshire, UK

Correspondence to:
Correspondence to:
Dr G Cox
Department of Respiratory Medicine, King’s Mill Hospital, Sutton-in-Ashfield, Nottinghamshire NG17 4JL, UK; giles.cox{at}sfh-tr.nhs.uk

A 65 year old woman with a 15 pack year smoking history had recently been diagnosed in the community with chronic obstructive pulmonary disease (COPD). She was admitted to hospital with progressive breathlessness and wheeze; her exercise tolerance had decreased from 800 metres to less than 50 metres over the last year. Her peak expiratory flow rate on admission was 150 l/min increasing to 320 l/min on discharge after treatment with oral steroids and nebulised bronchodilators.

She was readmitted 3 weeks later with a recurrence of her symptoms. A flow-volume loop suggested intrathoracic large airway obstruction (fig 1). Her chest radiograph showed a mid tracheal mass (fig 2A) which was confirmed on a computed tomographic (CT) scan (fig 2B). Flexible bronchoscopy revealed a polypoid tumour in the trachea 8 cm below the vocal cords causing a 60% reduction in tracheal diameter. Biopsies confirmed a non-Hodgkin’s lymphoma of B cell origin. There was no evidence of lymphoma involvement in any other site.

View larger version (13K): [in this window] [in a new window]   Figure 1  Flow-volume curve.

 

View larger version (84K): [in this window] [in a new window]   Figure 2  (A) Chest radiograph and (B) CT scan showing mid tracheal tumour.

 

She was initially treated with high dose steroids and received a single 10 Gy fraction of radiotherapy to the trachea. She responded rapidly and her breathing returned to her pre-morbid state. A repeat CT scan after 12 months showed no evidence of tumour at the primary site.

Primary non-Hodgkin’s lymphoma of the trachea is very rare. A Medline search identified only 13 case reports in the literature.^1,2 The diagnosis may be delayed as symptoms may be confused with those of asthma or COPD. Direct bronchoscopy and biopsy is the definitive investigation. Primary lymphoma of the trachea is a radiosensitive tumour and can be controlled with moderate doses of radiation.

1. Cormier WJ, Jazy KF, Shehata WM. Primary lymphoma of the trachea. Eur J Surg Oncol 1992;18:514–6.[Medline]
2. Fidias P , Wright C, Harris LH, et al. Primary tracheal non-Hodgkin’s lymphoma. A case report and review of the literature. Cancer 1996;77:2332–8.[CrossRef][Medline]

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This article has been cited by other articles:

• Korst, R. J. (2007). Primary Lymphoma of the Subglottic Airway in a Patient With Sjogren's Syndrome Mimicking High Laryngotracheal Stenosis. Ann. Thorac. Surg. 84: 1756-1758 [Abstract] [Full Text]  

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B-cell non-Hodgkin's lymphoma of trachea mimicking COPD

Andrew RL Medford

Thorax Online, 4 Jan 2005 [Full text]