AB 47. Incidental non-hodgkin lymphoma in a patient with squamous cell carcinoma of the lung: a case report

Background: The appearance of multiple malignancies in the same patient is a relatively rare occurrence, which can either be synchronous or metachronous. The etiology is multifactorial and some of the factors involved in the pathogenesis of these conditions include genetic predisposition, immunodefiency, radiation therapy, chemotherapy and various infectious agents. We report the case of a patient with squamous cell lung cancer in whom non-Hodgkin lymphoma was accidentally found in paratracheal lymph nodes.

Patients and methods: A 68-year-old man, with a known history of squamous cell carcinoma of the right lung, presented to our hospital with persevering hemoptysis. An emergency right pneumonectomy and regional lymphadenectomy was performed. A tumor, measuring 6 cm, was found in the middle and lower lobe.

Results: Histological evaluation revealed a malignant neoplasm composed of nests of large-sized, pleomorphic and atypical cells in fibrous stroma, intercellular bridges, pearl formation and areas of necrosis. Histological findings consisted with well differentiated squamous cell carcinoma of the lung, with lymph node metastasis. During histological examination in most paratracheal lymph nodes a diffuse expansion of small-sized lymphoid cells was unexpectedly found. The immunohistochemical examination led us to the diagnosis of a non- Hodgkin lymphoma. The patient died 18 days after surgical operation.

Conclusions: The incidence of multiple primary malignancies is expected to increase due to the better screening methods, which are essential for carcinoma diagnosis and follow-up. Simultaneously, the progress in molecular biology contributes to further understanding of carcinogenesis.