Asymptomatic tracheal MALT lymphoma discovered on spirometric findings presenting with elevated respiratory resistance

Abstract

Background: Central airway obstruction (CAO) may be caused by various etiologies. However, conventional chest X-rays are rarely diagnostic for patients with CAO.

Case presentation: We here described a 64-year-old asymptomatic female with tracheal mucosa-associated lymphoid tissue lymphoma discovered on spirometric findings during a complete physical examination. The plateau of forced expiratory flow was consistent with CAO. A decreased peak expiratory flow rate was noted at least 3 years before the diagnosis, and was attributed to an insufficient effort by the patient. Impulse oscillometric measurements, which were taken during quiet breathing and were effort-independent, suggested elevated respiratory resistance. These abnormalities completely disappeared after radiation therapy.

Conclusion: The addition of impulse oscillometry to spirometry may be useful for screening CAO in routine health examinations.

Figure 1

Time-course of the flow–volume curve suggesting long-term intrathoracic CAO. a Decreased peak expiratory flow rate 3 years before the diagnosis. b A plateau in FEF accompanied by relatively preserved FIF at presentation. c Improvements observed during radiation therapy at doses of 24 Gy. d Improvements observed after radiation therapy (36 Gy).

Figure 2

CT (a, d), endoscopy (b, e), and pathology (c) images before (a–c) and after (d, e) radiation therapy. c H&E stain ×40; insert ×400.

Figure 3

3D images of Rrs analyzed by impulse oscillometry before (a) and after (b) radiation therapy.