Onatsko Nicole, Karam Imad, Thida Aye, Attia Hagar, Bhamidipati Dedipya, Hamadi Rachelle, Gupta Raavi, Preet Mohan
Hematology and Oncology, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, USA.
Pathology and Laboratory Medicine, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, USA.
Cureus. 2024 Nov 11;16(11):e73462. doi: 10.7759/cureus.73462. eCollection 2024 Nov.
Extranodal marginal zone lymphoma (EMZL) is a rare subtype of non-Hodgkin's lymphoma characterized by the malignant transformation of lymphoid tissue at sites affected by chronic inflammation. Pleural marginal zone lymphoma (PMZL) is an infrequent manifestation of this condition. We report a case of PMZL co-occurring with primary lung adenocarcinoma. This case involves an 88-year-old female patient who presented to the emergency department with recurrent pleural effusions and symptoms suggestive of decompensated heart failure. A thoracentesis of the effusion revealed an aspergillus population. Throughout her hospitalization, the patient underwent multiple evaluations for malignancy; however, no conclusive findings emerged. Ultimately, PMZL and poorly differentiated primary adenocarcinoma of the lung were confirmed through random biopsies of the parietal pleura and lung opacities, respectively. The pleural pathology showed a monoclonal population of immunoglobulin G kappa, positive for cluster of differentiation (CD) markers CD20 and CD43. Consequently, she was treated with rituximab for PMZL, with plans to address the adenocarcinoma through stereotactic body radiation therapy (SBRT). Unfortunately, due to deconditioning from multiple hospitalizations and a pulmonary embolism, the patient chose comfort measures and subsequently passed away. Diagnosing PMZL can be challenging due to the absence of identifiable nodules. Reported cases have similarly required extensive investigations to reach a final diagnosis. While a direct correlation between chronic inflammation, frequent infectious pathogens, and the development of PMZL has yet to be established, a known association exists between EMZL and pathogens such as in gastric involvement and in ocular adnexa. This report highlights the difficulties in obtaining a diagnosis for PMZL and examines the various mechanisms that may have contributed to this unusual finding.
结外边缘区淋巴瘤（EMZL）是一种罕见的非霍奇金淋巴瘤亚型，其特征是慢性炎症影响部位的淋巴组织发生恶性转化。胸膜边缘区淋巴瘤（PMZL）是这种疾病的一种罕见表现形式。我们报告一例PMZL合并原发性肺腺癌的病例。该病例为一名88岁女性患者，因反复胸腔积液及提示失代偿性心力衰竭的症状就诊于急诊科。胸腔穿刺抽出物中发现曲霉菌。在其住院期间，患者接受了多次恶性肿瘤评估；然而，未得出明确结果。最终，分别通过壁层胸膜随机活检和肺部混浊灶活检确诊为PMZL和低分化原发性肺腺癌。胸膜病理显示免疫球蛋白G κ的单克隆细胞群，分化簇（CD）标志物CD20和CD43呈阳性。因此，她接受了利妥昔单抗治疗PMZL，并计划通过立体定向体部放疗（SBRT）治疗腺癌。不幸的是，由于多次住院导致身体状况不佳以及发生肺栓塞，患者选择了舒适护理措施，随后去世。由于缺乏可识别的结节，诊断PMZL可能具有挑战性。已报道的病例同样需要广泛的检查才能得出最终诊断。虽然慢性炎症、常见感染病原体与PMZL的发生之间尚未建立直接关联，但在EMZL与病原体之间存在已知关联，如在胃部受累时与幽门螺杆菌有关，在眼附属器受累时与沙眼衣原体有关。本报告强调了PMZL诊断的困难，并探讨了可能导致这一不寻常发现的各种机制。
