Endobronchial presentation of malignant lymphoma.

Abstract

The capricious nature of malignant lymphoma and its ability to mimic other disease entities is well documented and need not be re-emphasized. Recent literature indicates, however, that a significant percentage of pulmonary lymphomas may be primary to that organ and carry with them a more respectable prognosis if diagnosed and treated at an early stage (1-5). In the chest, malignant lymphoma may involve lymph nodes, pulmonary parenchyma, and the tracheobronchial tree. Hilar and mediastinal node enlargement is certainly the most common lesion but parenchymal involvement has been documented frequently in the recent literature (5, 6). Pulmonary tissue is probably the most frequent site of lymphomatous involvement second only to lymph node involvement itself. Endobronchial involvement is rare, and the presentation of the disease in this manner is even more unusual (6, 7). The matrix for the endobronchial lesion is the lymphoid tissue found in both diffuse and follicular aggregates in the mucosa and fibrous tissue surrounding the cartilage. Larger bronchi have lymph nodes along their course (7). The lesion is commonly a granulomatous infiltrate of the mucosa that is plaque-like and may ulcerate. However, it may also be nodular and partially or totally occlude the lumen. Usually, m~ltiple lesions are present, and single, polypOid, or adenomatous masses projecting into the bronchus are rarer. Displacement or nar-