Pulmonary MALToma Synchronous with Metastatic Prostate Adenocarcinoma: A Diagnostic Challenge.

OBJECTIVE: We describe the novel case of a patient presenting with pulmonary mucosa-associated lymphoid tissue lymphoma (pMALToma) synchronous with metastatic prostate adenocarcinoma. MATERIALS AND METHODS: We report the clinical, laboratory, radiological and histological findings of the above patient. RESULTS: While the patient's metastatic prostate adenocarcinoma responded well to chemo-radio-hormonal therapy, a persistent area of lung consolidation was noted and further investigated, leading to the diagnosis of concurrent pMALToma. CONCLUSION: It is important to pursue further investigation when there appears to be persistent change or altered disease response in malignancy if there is evidence for disease response elsewhere, as there may be two synchronous primary cancers. LEARNING POINTS: This is a novel case where pulmonary mucosa-associated lymphoid tissue lymphoma (pMALToma), a rare disease entity, presented synchronously and asymptomatically in a patient with metastatic prostate adenocarcinoma.From an instructive errors perspective, it is important to consider synchronous primary malignancy and pursue further investigations, as appropriate, when there appears to be persistent change or altered disease response if there is evidence for disease response elsewhere.

Successful endobronchial ultrasound-guided transbronchial needle aspiration of tumour thrombus in the left pulmonary vein to achieve histological diagnosis.

A symptomatic 66-year-old gentleman presented with a large left upper lobe mass, thought likely to be malignant. Further imaging suggested direct tumour extension into the left pulmonary vein. During a subsequent EBUS (endobronchial ultrasound) histological diagnosis was not achieved from sampling higher order lymph nodes, thus intra-procedurally the decision to sample, by Transbronchial Needle Aspiration (TBNA), an area thought to relate to tumour thrombus in the left pulmonary vein was taken. A diagnosis of a non-small cell lung cancer was made on histological testing of the tumour thrombus sample. Considering the bleeding risk, direct probe contact with the endobronchial wall was maintained for several minutes but no bleeding was observed. There were no complications as a result of the procedure. It may be safe to sample tumour thrombus from within a pulmonary vein via EBUS-TBNA to achieve positive histology.