Rare Endobronchial Presentation of Diffuse Large B-Cell Lymphoma in a Rural Midwestern Patient.

Abstract

We present a case of a rural, underserved patient from the rural Midwestern United States with an extremely unusual presentation of diffuse large B-cell lymphoma (DLBCL) in an endobronchial region. DLBCL in an endobronchial region is so rare that existing literature does not report the statistical prevalence. This case is of particular interest in the context of cancer disparities, given that oncology literature documents survival differences in lymphoma patients based on place of residence and treatment. This patient is a 68-year-old Caucasian male with an income level below the regional poverty line and who has cardiovascular comorbidities and a 72-pack-year smoking history. He currently resides alone in trailer park housing with minimal local family support. Key interventional aspects that equalize rural patient oncology outcomes include proper assessment, diagnosis, and prompt treatment of unusual or unlooked-for presentations of disease. Prior to the diagnosis, the patient presented to the hospital complaining of a cough, shortness of breath, nausea, and generalized weakness. The chest X-ray and CT revealed a suspicious consolidation in the left upper lobe; a follow-up bronchoscopy revealed an endobronchial lesion in the left lingulae. A biopsy of the tumor confirmed a rare endobronchial lymphoma and an active diagnosis of DLBCL. Following standard treatment with Rituxan-CVP, the patient is currently in remission and being treated for a lingering comorbid fungal lung infection consequent to his immunosuppressed state. His case represents a successful intervention in a rural, underserved region of an exceedingly rare lymphoma presentation.