Elsevier

Human Pathology

Volume 32, Issue 1, January 2001, Pages 129-132
Human Pathology

Case Studies
Synchronous pulmonary adenocarcinoma and extranodal marginal zone/low-grade B-cell lymphoma of MALT type

https://doi.org/10.1053/hupa.2001.20893Get rights and content

Abstract

A case of synchronous adenocarcinoma of lung and extranodal marginal zone/low-grade B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) is reported. Primary pulmonary non-Hodgkin's lymphoma is relatively rare, however, the majority of these lesions are low-grade B-cell lymphomas of MALT. After the stomach, the lung is the second most common location for such latter lesions. Lung adenocarcinoma in selected countries is fast becoming the leading form of non small-cell lung carcinoma. To our knowledge, this synchronous occurrence in the lung has not been previously reported. Such associations have been primarily limited to gastric lesions where an association with Helicobacter pylori infection has been identified. This case report highlights the importance of adjunctive diagnostic investigations such as molecular techniques in conclusive analysis of synchronous cases such as ours. HUM PATHOL 32:129-132. Copyright © 2001 by W.B. Saunders Company

Section snippets

Case history

This 74-year-old, retired forestry worker presented in March 1997 with a febrile illness and a history and clinical examination suggestive of a right-sided pneumonic process. He was a past smoker (not for 10 years of 20 packs/year. Past medical history was remarkable for hypercholesterolemia, positional vertigo, and gout, for which he was receiving Zyloric (Glaxo Wellcome, Inc, Research Triangle Park, NC) and Colchimax Hoechst Houde, Paris, France) medication. Specifically, there was no history

Pathologic findings

The lobectomy specimen contained an infiltrative peripheral mass of 4 × 1.5 × 2 cm, located 3 cm from the grossly normal resection margin. The tumor was white but heterogeneous in color, and somewhat soft and spongy in consistency with focal pleural surface retraction. Subaortic lymph nodes, lymph nodes located at the surgical bronchial stump, intertracheobronchial nodes, and fissural lymph nodes sampled were all grossly free of metastatic deposits. Light microscopy showed an invasive

Discussion

The determination of the exact biological nature of the lymphocytic component, viz-a-viz reactive versus a neoplastic infiltrate, was the main diagnostic dilemma in this case. Although the overall histological impression was consistent with that of a low-grade B-cell lymphoma of MALT with lymphoepithelial lesions, the inability to demonstrate light chain restriction by IHC on FFPE tissue somewhat mitigated against this diagnosis and favored the possibility that the B-cell infiltrate merely

Acknowledgements

We thank F. Devez for his expertise in the PCR technique used in this case.

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