Correct!
3. Flexible fiberoptic bronchoschopy
The right lung nodule is at least partially calcified and therefore likely, although not definitely benign. Therefore, a conservative, observational approach to the management of this lesion is appropriate. Instead, attention turns towards the incidentally discovered airway lesion. The lesion resides within the left mainstem bronchus and is not accessible via either percutaneous transthoracic needle biopsy or video-assisted thoracoscopic biopsy. 68Ga-citrate (gallium) scanning would not provide management-altering information. If the lesion shows active 68Ga uptake, the diagnosis of carcinoid tumor would be a distinct possibility, but tissue sampling would nevertheless be required. The absence of 68Ga tracer uptake within the lesion would not exclude the possibility of an aggressive lesion and tissue sampling is still required. Similarly, the presence of active tracer utilization at 18FDG-PET scanning would raise the possibility of an aggressive intervention, but would be non-specific as regards etiology, still necessitating a tissue diagnosis. The lack of tracer uptake at 18FDG-PET would not preclude the need for a tissue diagnosis; both benign and malignant endobronchial lesions may, or may not, show increased tracer utilization at 18FDG-PET.
Flexible fiberoptic bronchoscopy with biopsy was performed (Figure 5). (Editor's note: the memory required for figure 5 is quite large and the file may be slow to load)
Figure 5. Virtual bronchoscopy provides the endoluminal perspective of this lesion.
Biopsy material showing CD20+ B-lymphocytes co-expressing bcl-2 and lacking expression for CD3, CD10, bcl-6, and cyclin D1, and without evidence of kappa or lambda immunoperoxidase staining, supporting the diagnosis of lymphoma
Diagnosis: Extranodal marginal zone lymphoma arising from mucosa-associated lymphoid tissue (MALT).
References