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