title: Endobronchial involvement as an extremely rare manifestation of the Waldenström's disease.
abstract: Pulmonary infiltration is an infrequent organ involvement in Waldenström's disease (WD). Diffuse infiltration, isolated parenchymatous nodules, and pleural effusion are the most common manifestations of WD, while endobronchial mass is extremely rare. We present a case report of a 66-year-old man with a long-standing history of WD, who developed febrile neutropenia after therapy with rituximab, cyclophosphamide, and dexamethasone. X-ray and CT scan showed consolidation consistent with right-sided pneumonia. Surprisingly, bronchoscopy revealed an endobronchial tumor obstructing the right lower lobe (RLL) and two smaller granulations. Biopsies were obtained and recanalization of the RLL bronchus was performed. Immunohistological staining of the samples was consistent with lymphoplasmacytic lymphoma. Despite the change in therapy the patient died 6 weeks later. A review of published literature revealed only two case reports of endobronchial involvement in WD to this day. While one of the case reports described a patient with diffuse submucosal infiltration of the airways, the other one presented a patient with bronchus-obstructing tumor similar to the case reported here.
authors.affiliation: Department of Tuberculosis and Respiratory Diseases, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic.
authors.forename: Hana
authors.initials: H
authors.lastname: Bartáková
authors.affiliation: Department of Internal Medicine and Haematology, Third Faculty of Medicine, Charles University in Prague and Faculty Hospital Královské Vinohrady, Prague, Czech Republic.
authors.forename: Jan
authors.initials: J
authors.lastname: Novák
authors.affiliation: Institute of Pathology, General University Hospital, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.
authors.forename: Radek
authors.initials: R
authors.lastname: Jakša
authors.affiliation: Department of Radiology, General University Hospital, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.
authors.forename: Jiří
authors.initials: J
authors.lastname: Beneš
authors.affiliation: Department of Tuberculosis and Respiratory Diseases, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic.
authors.forename: Jiří
authors.initials: J
authors.lastname: Votruba
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D001707:Biopsy, Needle; D001984:Bronchial Neoplasms / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D001999:Bronchoscopy / Q000379:methods; D003131:Combined Modality Therapy / Q000379:methods; D018450:Disease Progression; D017809:Fatal Outcome; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D035583:Rare Diseases; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed / Q000379:methods; D008258:Waldenstrom Macroglobulinemia / Q000150:complications* / Q000175:diagnosis
keywords: Waldenström's disease; bronchoscopy; interventional pulmonology; recanalization