2023 World Conference on Lung Cancer (Posters)-EP14.03. Ebstein-Barr Virus-Associated Pulmonary Lymphomatoid Granulomatosis with Trigeminal Nerve Involvement

EP14.03. Ebstein-Barr Virus-Associated Pulmonary Lymphomatoid Granulomatosis with Trigeminal Nerve Involvement - PDF(Slides)

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Lymphomatoid granulomatosis (LYG) is a rare B-cell lymphoproliferative disorder associated with the Epstein-Barr virus (EBV). It primarily affects the lungs, with skin, central nervous system (CNS), and other organs being less commonly involved. This case report discusses a 65-year-old man who was diagnosed with grade 3 pulmonary LYG and treated with six cycles of R-CHOP chemotherapy. The patient had follow-up PET/CT exams that showed fluctuating presence of tracer-avid lesions in the lungs, skin, and subcutaneous tissues. He subsequently developed left trigeminal nerve symptoms, and imaging revealed a lesion in the left trigeminal nerve. Skin biopsy confirmed recurrent LYG, and the patient received systemic therapy along with treatment for the neurologic symptoms. After treatment, PET/CT and MRI showed resolution of the trigeminal lesion but persistent LYG activity elsewhere.<br /><br />LYG is characterized by a high concentration of T cells and atypical B cells, which are positive for EBV serology. The grading of LYG, based on biopsy findings, determines the therapeutic approach and correlates with the severity and outcome of the disease. Imaging plays a crucial role in diagnosing and monitoring LYG, with PET/CT being used to evaluate the metabolic behavior of LYG lesions and guide tissue sampling for diagnosis. However, PET/CT cannot distinguish LYG from large B-cell lymphoma, which may have a similar pattern of FDG avidity.<br /><br />LYG has a variable clinical presentation and outcome, with the lung being the most commonly affected organ. The disease can mimic primary or secondary malignancies, making accurate diagnosis and grading important for appropriate treatment. This case report highlights the importance of imaging modalities such as PET/CT and MRI in staging and monitoring the post-therapeutic evolution of LYG, especially in cases involving the lungs, CNS, and skin.

Asset Subtitle

Ba Nguyen

Meta Tag

Speaker Ba Nguyen

Topic Other Thoracic Malignancy

Keywords

Lymphomatoid granulomatosis

B-cell lymphoproliferative disorder

Epstein-Barr virus

lungs

skin

central nervous system

PET/CT exams

trigeminal nerve

biopsy findings

imaging modalities