DIFFUSE LARGE B-CELL LYMPHOMA PRESENTING AS DIFFUSE BILATERAL INNUMERABLE PULMONARY NODULES

TOPIC: Lung Cancer TYPE: Medical Student/Resident Case Reports INTRODUCTION: Diffuse large B-cell lymphoma (DLBCL) may rarely manifest as a primary pulmonary or with secondary lung involvement. Typical radiologic presentations include chronic, indolent airspace consolidations, focal masses perilymphatic nodules.(1) The objective of this report is to present rare involvement DLBCL presenting bilateral diffuse innumerable nodules on chest computed tomographic (CT) imaging. This presentation has only previously been seen in the setting acquired immunodeficiency syndrome (AIDS).(2) CASE PRESENTATION: A 67-year-old Caucasian woman history stage IV associated wall mass presented emergency department pain and progressively worsening shortness breath. Increasing oxygen requirements from baseline 2L 4L via nasal cannula, maintain pulse oximetry reading 95% was noted. Physical examination unremarkable clear fields.Serology revealed bi-cytopenia, hemoglobin 11.0g/dL (normal 11.5-15.5g/dL) platelets 81 k/uL 150-400k/uL). LDH CRP were elevated at 527U/L 135-214U/L) 6.4mg/dL <0.9mg/dL) respectively. CT-chest contrast showed no evidence embolism. However, noted (Figure 1). left lower had increased size. Broncho-alveolar lavage negative for viral, bacterial fungal etiologies. HIV serology, acid fast bacillus culture stain also negative. Transbronchial needle aspirate enlarged lymph nodes positive lymphoma. Left lobe trans-bronchial biopsy mild non-specific interstitial fibrosis but granulomatous inflammation, neoplasm, acute infection. Due high suspicion progression her underlying cause nodules, CT-guided performed. sheets large, CD5, 10 20 transformed lymphocytes seen. Her proven be due disease. She received chemotherapy bendamustine rituximab. returned baseline, she discharged home one week later. DISCUSSION: case nodules.(2) patient extensive unlike previous described immunocompetent patients. CONCLUSIONS: We suspect lymphatic spread which occur generalized disease.(3) REFERENCE #1: Lewis E, Caskey C, Fishman E. Lymphoma lung: CT Findings 31 AJR Am J Roentgenol. 1991 Apr;156(4):711-4. #2: Harbor N. Rapidly progressive an Aids patient: fatal report. Journal Hospital Medicine. 2015 March;abstract 604(10)supply 2. #3: Cheng Su Y, Chao T et al. Intralymphatic finding poor prognosis extranodal involvements. Surg Pathol. 2018 May;42(5):616-624. DISCLOSURES: No relevant relationships by Tanya Marshall, source=Web Response Atul Mehta, Prince Ntiamoah, Joseph Parambil,