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Vol. 54. Núm. 6.Junio 2018
Páginas 301-354
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Vol. 54. Núm. 6.Junio 2018
Páginas 301-354
Clinical Image
DOI: 10.1016/j.arbres.2018.01.003
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A Lymph Node Metastatic Lung Adenocarcinoma in a Previous Mediastinal Lymphoma
Adenocarcinoma pulmonar metastásico en ganglio linfático de un linfoma mediastinal previo
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Filipa Ramalho Fernandesa,
Autor para correspondencia
filipasrfernandes@gmail.com

Corresponding author.
, Jorge Dionísiob, Duro da Costab
a Department of Pneumology, Unidade Local de Saúde da Guarda E.P.E. – Hospital Sousa Martins, Portugal
b Department of Pneumology, Instituto Português de Oncologia de Lisboa Francisco Gentil E.P.E., Portugal
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A 50-year-old female, smoker, with a past-history of a lymphocytic lymphoma in long last remission, presented with a tender large right lower neck mass, for which multiple fine needle aspiration cytology only disclosed necrotic material.

Chest CT revealed a peripheral lung nodule, in right upper lobe (Fig. 1A), with multiple pathologic mediastinal lymph nodes (Fig. 1B).

Fig. 1.
(0,41MB).

(A) Chest CT (axial plan (AP)): spiculated nodular densification of 30×20mm, with air bronchogram in the upper lobe of the right lung; (B) chest CT (axial plan (AP)): supraclavicular and mediastinal heterogeneous (partially necrotic) adenopathies; (C) endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA): TBNA of thoracic lymph node in station 4R; (D) atypical morphology of TTF1+adenocarcinoma, on a background of lymphocytesC, 400×; (E) flow cytometry: pathological B lymphocytes marked in red, compatible with lymphocytic lymphoma.

The EBUS allowed the identification and transbronchial needle aspiration (TBNA) of thoracic lymph nodes in station 4L, 4R, 7 and 11R (Fig. 1C).

EBUS-TBNA in stations 4L, 4R, 7 and 11R was consistent with lymphocytic lymphoma confirmed by flow cytometry. However, in stations 4R and 11R lymph node infiltration, with metastatic TTF1+ lung adenocarcinoma, was also documented (Fig. 1D/E).

Although carcinoma of multiple primary origins has been associated with previous or concomitant lymphoma, lymph node metastasis of adenocarcinoma in lymphomatous lymph nodes is a rare situation. Chronic immune suppression caused by lymphoma and/or cytostatic treatment seems a plausible predisposing factor for multiple primary tumors.1,2

This case highlights the need for a complete diagnostic work-up to elucidate the various clinical hypotheses, particularly in a nearby pathologic and draining territory.

References
[1]
T.K. Lee, R.T. Myers, M. Scharyj, R.B. Marshall
Multiple primary malignant tumours (MPMT): study of 68 autopsy cases (1963–1980)
J Am Geriatr Soc, 30 (1982), pp. 744-753
[2]
C.G. Moertel, A.B. Hagedorn
Leukemia or lymphoma and coexistent primary malignant lesions: a review of the literature and a study of 120 cases
Blood, 12 (1957), pp. 788-803
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