Multifocal Extranodal Involvement of Diffuse Large B-Cell Lymphoma

Endobronchial involvement of extrapulmonary malignant tumors is uncommon and mostly associated with breast, kidney, colon, and rectum carcinomas. A 68-year-old male with a prior diagnosis of colon non-Hodgkin lymphoma (NHL) was admitted to the hospital with a complaint of cough, sputum, and dyspnea. The chest radiograph showed right hilar enlargement and opacity at the right middle zone suggestive of a mass lesion. Computed tomography of thorax revealed a right-sided mass lesion extending to thoracic wall with the destruction of the third and the fourth ribs and a right hilar mass lesion. Fiberoptic bronchoscopy was performed in order to evaluate endobronchial involvement and showed stenosis with mucosal tumor infiltration in right upper lobe bronchus. The pathological examination of bronchoscopic biopsy specimen reported diffuse large B-cell lymphoma and the patient was accepted as the endobronchial recurrence of sigmoid colon NHL. The patient is still under treatment of R-ICE (rituximab-ifosfamide-carboplatin-etoposide) chemotherapy and partial regression of pulmonary lesions was noted after 3 courses of treatment. 1. Introduction Endobronchial involvement of extrapulmonary malignant tumors is uncommon and mostly associated with breast, kidney, colon, and rectum carcinomas [1, 2]. Although the lung is a frequent site for lymphoma involvement, endobronchial metastasis of non-Hodgkin lymphoma (NHL) is extremely rare. Extranodal lymphomas originating in solid organs account for one-third of all cases of NHL. Gastrointestinal (GI) tract is the most common site of extranodal lymphomas. GI tract lymphomas occur most commonly in the stomach and colorectal NHL accounts for only 10–20% of them [3]. NHL originates from B or T lymphocytes. Mucosa-associated lymphoid tissue (MALT) and diffuse large B-cell lymphoma (DLBCL) are the most commonly observed histological subtypes in the GI tract [4]. DLBCL of the GI is an aggressive lymphoma which more commonly affects males with a median age of 50–60 years [5]. The reported 5-year survival is relatively poor, ranging between 27 and 55%. Here, we present a patient with endobronchial involvement of diffuse large B-cell lymphoma who has completely remitted sigmoid colon NHL as a primary site. 2. Case Report A 68-year-old male was admitted to the hospital with a complaint of diarrhea, abdominal pain, weight loss, and hematochezia. Ulcerated plaque-like lesions with local necrotizing areas along the 10？cm segment of sigmoid colon were detected in colonoscopy. The pathological examination of biopsy material was suggestive