Coexistent Primary Lung Adenocarcinoma and Mantle Cell Lymphoma: A Case Report

Abstract

Introduction: Mantle cell lymphoma (MCL) is a type of B-cell lymphoma, comprising 3-10% of non-Hodgkin lymphomas (NHL). Although there is a well-known increased risk for secondary malignancies after treatment in NHL survivors, the concomitant diagnosis of a primary lung cancer co-existent with lymphoma at initial presentation - is very rare. We present a case of concomitant primary lung adenocarcinoma with MCL. CASE PRESENTATION: A 55 year-old female, recently diagnosed with mantle-cell lymphoma (MCL), was referred after a pre-chemotherapy screening chest computed tomography scan (CT) identified severe emphysema, multiple indeterminate pulmonary nodules and a 1.7 x 1.1 cm, subpleural, thin-walled cavitary lesion in right the upper lobe (RUL). She was a 30 pack-year smoker with stable chronic bronchitis and sinusitis, scant hemoptysis, chills and 24-lb weight loss over 2 months. Tuberculosis testing was negative. Her mother had lung cancer. Physical examination was unremarkable. Our differentials included infection, malignancy and vasculitis. A bronchoscopy with lavage (BAL) revealed 87% macrophages and cultures grew 1+ Aspergillus flavus. Cytology and cytoplasmic antineutrophil antibodies were negative. CT chest at 2-month follow up showed stable pulmonary nodules and persistent RUL cavitary lesion. A VATS biopsy was performed to exclude infection prior to initiation of chemotherapy for MCL and revealed a lepidic predominant, well-differentiated adenocarcinomatous nodule (T1a) with foci of lymphoid infiltrate consistent with lung involvement by mantle cell lymphoma. DISCUSSION: Simultaneous presentation of primary lung adenocarcinoma with lymphoma is exceedingly rare. We found only one case report of incidental pleural involvement with MCL and primary lung adenocarcinoma [1]. Barista et al. [2] reported a series of patients with MCL who had an increased predisposition to second primary tumors at diagnosis (mostly urological). Conclusion(s): Our case demonstrates two different populations of tumor cells within a subpleural lung nodule without any pleural involvement. The nature of this association is not clear however it underscores the importance of surveillance for synchronous malignancies in patients with newly diagnosed MCL.