Tulika Saggar, MD1, Atul Sinha, MD1, James R. Pellegrini, MD2, Ana P. Rivera, MD3, Krishnaiyer Subramani, MD1, Paul Mustacchia, MD, MBA1 1Nassau University Medical Center, East Meadow, NY; 2Nassau University Medical Center, Great River, NY; 3Nassau University Medical Center, Amityville, NY
Introduction: Mucosa-associated lymphoid tissue (MALT) lymphoma is a rare gastric neoplasm, usually occurring in patients in their 5th and 6th decade of life. It has a strong association with Helicobacter pylori infection and commonly spreads to lymph nodes, liver, lungs, and bone marrow. We present a unique case of a chronic smoker being evaluated for primary lung cancer who was found to have metastatic MALT lymphoma.
Case Description/Methods: A 68-year-old male was admitted from the oncology clinic for a 5 month history of night sweats, 40lb weight loss, and submandibular lymphadenopathy. Patient was being worked up for pulmonary nodules on xray and had a 30-pack year smoking history, but quit smoking 10 years ago. CT done on admission showed multiple airspace opacities as well as marked gastric thickening. Upper endoscopy was performed and a 5cm by 4cm friable fungating mass was found on the lesser curvature of the stomach. Biopsies of the mass were consistent with MALT lymphoma, however, were H pylori negative. CT-guided core biopsy of pulmonary masses were also consistent with MALT lymphoma. Patient was referred for chemotherapy and is doing well today.
Discussion: We demonstrated a case where physicians had a strong suspicion from primary lung cancer in a chronic smoker but was found to have an unexpected primary cancer. This case reinforces the need for not only a thorough staging of cancer, but also the consideration of other primary sites. Had this patient undergone just biopsy of lung lesions, without CT of abdomen done prior, it would have led to a delay in diagnosis. Fortunately, the correct diagnosis was made and the patient had a good outcome.
Figure: Metastatic pulmonary lesions on CT and primary MALT lymphoma seen on EGD
Disclosures:
Tulika Saggar indicated no relevant financial relationships.
Atul Sinha indicated no relevant financial relationships.
James Pellegrini indicated no relevant financial relationships.
Ana Rivera indicated no relevant financial relationships.
Krishnaiyer Subramani indicated no relevant financial relationships.
Paul Mustacchia indicated no relevant financial relationships.
Tulika Saggar, MD1, Atul Sinha, MD1, James R. Pellegrini, MD2, Ana P. Rivera, MD3, Krishnaiyer Subramani, MD1, Paul Mustacchia, MD, MBA1. P3403 - MALT Lymphoma Presenting With Pulmonary Metastasis in a Chronic Smoker, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.
