Low Grade Pulmonary Lymphomatoid Granulomatosis with an Endobronchial Mass

Abstract

Lymphomatoid granulomatosis (LYG) is an angiocentric and angiodestructive neoplastic proliferation of B and T lymphocytes commonly involving the lungs. Epstein-Barr virus is commonly detected in lesional cells. We report a case of a 54-year-old female with underlying monoclonal gammopathy of unknown significance who presented with a 4 week history of dyspnea and cough. Computed tomography scan of the chest showed multiple lung nodules as well as endobronchial narrowing causing atelectasis at the left upper lobe. Bronchoscopic findings revealed obstruction at the lingula segment due to endobronchial mass as a rare presentation. Bronchoscopic biopsy was diagnosed with LYG grade 1. After treatment, the endobronchial mass and lung lesions were completely resolved. However, the patient eventually evolved to malignant lymphoma after 1 year.

Central airway obstruction from lymphomatoid granulomatosis treated with an endobronchial stent

“…One patient with tracheal mucosa-associated lymphoid tissue lymphoma received an endobronchial stent followed by chemotherapy, and had the stent removed 35 days after chemotherapy [ 11 ]. There are 3 case reports to date describing endobronchial involvement in LG [ [3] , [4] , [5] ], and no reported case of central airway obstruction leading to respiratory failure from underlying LG. Our patient's stent was removed 4 months after chemotherapy initiation and thus it appears that stent placement in conjunction with chemotherapy treatment, and eventual stent removal is a reasonable treatment strategy in patients with CAO from LG.…”

“…Lymphomatoid granulomatosis (LG), a rare Epstein Barr virus (EBV) associated B cell lymphoproliferative disorder, typically causes bilateral lower lobe lung nodules, and only rarely causes central airway obstruction [ 2 ]. Very few cases of LG endobronchial involvement have been reported in the English literature, two treated with chemotherapy [ 3 , 4 ] and one with pneumonectomy [ 5 ]. There is no data on bronchoscopic interventional options for these patients.…”

Lymphomatoid Granulomatosis: Rare Radiologic Presentation as a Solitary Pulmonary Mass

“…Rarely, LYG presents as a solitary mass in the lung [8][9][10] . We report a rare radiographic presentation of pulmonary lymphomatoid granulomatosis as a single mass with the obstruction of right main stem bronchus.…”