Relapse of Non-Hodgkin’s Lymphoma Involving the Trachea: Acute Subglottic Obstruction

Relapsing lymphoma involving the trachea causing tracheal obstruction is exceedingly uncommon. Despite its rarity, it should be considered in the differential diagnosis when a patient with known lymphoma presents with signs of airway obstruction such as stridor. We report an unusual case of relapsing non-Hodgkin’s lymphoma with tracheal involvement in a 57-year-old female and review the relevant literature. It is highly unusual for relapsing lymphoma to involve the trachea causing tracheal obstruction. Despite its rarity, it can present with life-threatening airway obstruction which may be rapidly progressive requiring immediate surgical intervention such as tracheostomy. 1. Introduction The most common etiologies of acute upper airway obstruction include infection, neoplasms, trauma, foreign bodies, and angioedema. Tracheal neoplasm accounts for less than 0.1% of all malignancies [1]. Primary malignant tumors of the trachea are uncommon. The most prevalent histologies in adult primary tracheal tumors are squamous cell carcinoma and adenoid cystic carcinoma [2]. Although extranodal lymphoma is reasonably common, a primary presentation of extranodal lymphoma involving the trachea is extremely unusual. Relapsing lymphoma of the trachea is even more rarely encountered. In non-Hodgkin’s lymphoma, diffuse large B-cell lymphoma is the most common subtype which accounts for approximately 25% of cases [3]. The incidence of diffuse large B-cell lymphoma is approximately 7 cases per 100,000 people [4]. Relapse typically occurs in the first 2-3 years after treatment and usually occurs at a different site which is separate from the primary presentation [5]. We report the first case in the literature of relapsing non-Hodgkin’s lymphoma in the trachea who presented with an acutely threatened airway requiring immediate surgical tracheostomy. 2. Case Report A 57-year-old female with a background of B-cell non-Hodgkin’s lymphoma in remission presented to the emergency department with rapidly progressive noisy breathing and dyspnoea that was worse when supine over the last 7 days. There were associated symptoms of cough and hemoptysis as well as constitutional symptoms including fever, night sweats, and weight loss over this period. She denied voice changes, dysphagia, odynophagia, or trismus. The patient was originally diagnosed with B-cell non-Hodgkin’s lymphoma 6 months prior and had undergone six cycles of chemotherapy according to the German Multicenter Study Group for Adult Acute Lymphoblastic Leukemia (GMALL) 2002 protocol. On review, she was afebrile with audible