Severe Central Airway Obstruction Secondary to a Endobronchial Central Airway Obstruction Secondary to Primary B-cell Lymphoma With : three case reports and literature review

Severe Central Airway Obstruction Secondary to a Endobronchial Central Airway Obstruction Secondary to Primary B-cell Lymphoma With : three case reports and literature review | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Severe Central Airway Obstruction Secondary to a Endobronchial Central Airway Obstruction Secondary to Primary B-cell Lymphoma With : three case reports and literature review Cai-li LI, Wei ZHOU, Mo CHEN, Shuo LI, Bao-yuan CHEN, Yu-bao WANG, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5661329/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 15 Oct, 2025 Read the published version in BMC Pulmonary Medicine → Version 1 posted 14 You are reading this latest preprint version Abstract Central airway obstruction can be secondary to extrinsic compression from surrounding structures, direct extension from an adjacent tumor, metastatic disease and, less commonly primary intrinsic endobronchial malignancies.To our knowledge, nearly few reports of an isolated central airway lesion by primary lymphoma without extrathoracic or extra-nodal manifestation have been published to date. This is the first case about malignant trachea obstruction caused by primary B-cell lymphoma without involvement of the main stem bronchi, lobar bronchus and mediastinum. Cases presentation: The three patients were admitted to hospital for coughing accompanied by wheezing that recent exacerbated. The chest computed tomography scan revealed a soft tissue-density mass within the central trachea. Pathological analysis showed that these were lymphoma. No enlarged mediastinal or cervical lymph nodes were found.. Conclusion: A high suspicion of endobronchial lymphoma is warranted in the differential diagnosis of a pathological mass located in central airway. Primary B-cell Lymphoma central airway obstruction Extranodal Tracheal stenosis Figures Figure 1 Figure 2 Figure 3 Introduction Central airway obstruction (CAO), an occlusion of more than 50% of the trachea, main stem bronchi, or lobar bronchus, may contribute to severe clinical symptoms and high mortality rate. It can be secondary to extrinsic compression from surrounding structures, direct extension from an adjacent tumor, metastatic disease and, less commonly primary intrinsic endobronchial malignancies( 1 ) .The most common etiology is primarily bronchogenic carcinoma, with a percent of more than 50% of malignant CAO from non-small cell lung cancer as squamous cell carcinoma as previously mentioned( 2 ). Small cell lung cancer may also directly invade the central airways causing obstruction from endobronchial involvement or cause central airway compression as a perihilar mass with lymphadenopathy( 3 ). The same as thyroid, laryngeal, and esophageal malignancies. Nonmalignant causes of CAO are due to benign strictures related to post-intubation tracheal stenosis, autoimmune and infectious diseases ( 4 ). Although rare, primary tracheobronchial lymphoma presented as extranodal lymphoma may also cause airway obstruction ( 1 ). Primary tracheobronchial lymphoma can cause respiratory failure ( 5 ), life-threatening airway obstruction, and lead to poorer prognosis. Here we report three cases of primary tracheobronchial B-cell Lymphoma in which the patients was suffering rare, obstruction of the central airway. To alleviate the airway obstruction, we performed interventional bronchoscopy involving laser tumor ablation. We present a literature review on primary tracheal lymphoma to enhance our understanding of the clinical features and management of this uncommon manifestation of lymphoma. Case Presentation Case 1 A 78-year-old female was referred to our hospital with complaints of Cough with sputum for over a year, worsened with wheezing for 3 months. She received some cycles of antibiotics as lower respiratory tract infections with some beneficial effect before admission. The patient denied any headaches, stridor, and gastrointestinal or urinary symptoms. She denied a medical history of hypertension, diabetes, or asthma and denied medications or previous surgeries. She has a history of passive smoking. Three months before admission, her dyspnea started worsening after exertion. However, she denied fever or other symptoms. The lung function test was completed, which showed extremely severe obstruction of ventilation dysfunction, slight decrease in diffusion function, and the normal range of residual volume/total lung capacity ratio(Figuer1A). The chest computed tomography(CT) scan revealed a soft tissue-density nodule within the trachea and thickened trachea wall. The nodule is closely attached to the left posterior wall, causing narrowing of the airway lumen. The secretions and mucus in the lumen of the trachea, the main bronchus on both sides were considered (Figuer 1B, 1C). She was referred to our hospital to confirm the diagnosis with a bronchoscopy under general anesthesia, which is a routine procedure. The physical examination evidenced a temperature, 37.1 ℃; respiration rate, 22 bpm; pulse, 72 bpm; blood pressure, 144/70 mmHg, and oxygen saturation in 92% with no oxygen supplementation. Breathing sounds were increased at the base of the right lung. No enlarged lymph nodes were detected. Blood gas analysis showed hypoxemia (pH 7.413; PaO2, 67.5 mmHg; PaCO2, 45 mmHg). Blood cell count was normal. A bronchoscopy was performed and revealed a significant soft mass that originated in the upper segment of the main bronchus. The lesion was occluding the lumen of the main bronchus, which probably explained severe ventilation dysfunction in lung function. With the displacement of the lesion, ventilation of the main bronchus was achieved while the endoscopic resection was carried out. Laser tumor ablation was used to achieve enucleation of the mass (Fig. 1 D-F). Pathological examination Revealed mucosa- associated lymphoid tissue lymphoma of extra-nodal marginal zone B cells (MALT lymphoma)(Fig. 1 G), with diffuse sheets of large round cells staining positive for CD20、BCL2 and MLM1, and negative for CD3. The patient refused further PET-CT examination and treatment due to financial reasons. Case2 A 69-year-old female was referred to our hospital with complaints of Cough and Cough with sputum intermittently for a month. The patient has been in good health in the past. She denied a medical history of hypertension, diabetes, or asthma and denied medications or previous surgeries. she denied exertional dyspnea, fever, or other symptoms. The lung function test was normal. The chest computed tomography(CT) scan revealed a soft tissue-density nodule in the posterior tracheal lumen, causing narrowing of the airway lumen. The lesion appeared heterogeneous with a maximum cross-sectional area of 14mm*9mm and unclear demarcation with the esophagus(Fig. 2 A ). She was referred to our hospital to confirm the diagnosis with a bronchoscopy. The physical examination evidenced a temperature, 36.5 ℃; respiration rate, 29 bpm; pulse, 78 bpm; blood pressure, 114/67 mmHg, and oxygen saturation in 96% with no oxygen supplementation. Breathing sounds were normal. No enlarged lymph nodes were detected. Blood cell count was normal. A bronchoscopy was performed and revealed a significant soft mass at the upper trachea near the glottis, causing central airway obstruction. The tumor was eliminated by laser ablation and biopsy forceps, inducing the trachea much more clear than before (Fig. 2 ). Pathological examination revealed that lymphatic system malignant diseases are not excluded(Fig. 2 C), with diffuse sheets of large round cells staining positive for CD20、BCL2, and partial positive for CD3 in our hospital. The pathological consultation at an outpatient oncology specialty hospital has MALT lymphoma.This patient was transferred to the hematology department for further chemotherapy. Case3 A 47-year-old male was referred to our hospital with complaints of Cough with sputum for 2 months. He denied a medical history of hypertension, diabetes, or asthma and denied medications or previous surgeries. He did not has a history of smoking. Two months before admission, his dyspnea started worsening after exertion. The lung function test was completed in outpatient department, which showed a plateau-like change in expiratory phase, with a mild reduction in diffusion function (Fig. 3 A). The chest computed tomography(CT) scan revealed thickened trachea wall in Right anterior with ring-like enhancement (Fig. 3 B ). He was referred to our hospital to confirm the diagnosis with a bronchoscopy. The physical examination evidenced a temperature, 36.4 ℃; respiration rate, 18 bpm; pulse, 86 bpm; blood pressure, 136/73 mmHg, and oxygen saturation in 96% with no oxygen supplementation. Breathing sounds were normal. No enlarged lymph nodes were detected. The chest computed tomography(CT) scan revealed thicken bronchial wall in a ring-like pattern. A bronchoscopy was performed and revealed a significant soft mass that originated in the upper segment of the main bronchus. The lesion was occluding the lumen of the main bronchus, which probably explained severe ventilation dysfunction in lung function. A biopsy was performed via bronchoscope (Fig. 3 D-E). Pathological examination Revealed B cell lymphoma (Fig. 3 F), with CD20 positive for B cells distributed in patches; CD3, CD5, CD7 slightly more positive for T cells. Discussion Primary neoplasms of the trachea are rare, comprising only 0.2% of all malignancies ( 6 ). Furthermore, primary tracheal non-Hodgkin’s lymphoma accounts for only 0.2–3% of all tracheal tumors ( 7 , 8 ). Extra-nodal lymphoma itself is not uncommon, but the rate of extranodal lymphoma involving tracheal bronchial is only 3.6% ( 9 ). Although Various histological subtypes of primary tracheal lymphoma exist, the most common types are mucosa-associated lymphoid tissue (MALT) lymphoma( 10 ), and diffuse B-cell lymphomas( 11 ). This low grade malignancy of MALT lymphomas has a tendency to remain localised to the primary site and to respond favourably to local treatments such as surgery and/or radiotherapy, with more favourable outcome and prognosis than for other extra-nodal lymphomas reported in the literature ( 12 ). B cell lymphomas were also described but are less common (20– 25% of primary pulmonary lymphoma) ( 13 ). As in our case, two cases were MALT lymphoma and one case was B-cell lymphoma. Endobronchial lymphoma is classified into two types depends on the pattern of involvement. Type I includes diffuse submucosal infiltration caused by systemic lymphoma, which can be caused by hematogenous or lymphatic dissemination. Type II (similar to our patients) includes airway involvement caused by local tumors originating from adjacent lymph nodes or directly from bronchial-associated lymphoid tissue. Type II lesions were associated with respiratory obstruction symptoms such as cough or wheezing in all cases, as demonstrated by our patients. The most common symptoms are dyspnea, cough and wheezing, which are non-specific. It was initially misdiagnosed as bronchial asthma due to the presence of symptoms and signs. But clinical manifestations depend on the severity of central airway obstruction. Patients with mild tracheal stenosis (stenosis less than 50%) are often asymptomatic. Moderate occlusions that present an airway obstruction between 51% and 70% of the lumen may present with cough, hemoptysis, shortness of breath, chest pain, wheezing, and recurrent pneumonia or atelectasis. Moderate occlusions can cause airway narrowing by 51–70%, and patients may experience symptoms such as coughing, hemoptysis, dyspnea, chest pain, wheezing, and recurrent pneumonia or atelectasis.Whereas in patients who present with acute respiratory failure, severe stenosis (> 70%) must be suspected, which should be taken with immediate procedure to eliminate the airway obstruction and maintain the adequate ventilation. CT with tracheal protocols is the procedure of choice for accurate estimations of lesion length, degree of airway narrowing, patency of the distal airway, anatomic relationships to structures surrounding the airways 10. Thin slices can be used for 3-D reconstruction, which is particularly useful for preoperative analysis for the airways in respect to surrounding structures and a virtual bronchoscopic evaluation. Dynamic CT is effective for the diagnosis of TBM. Although MRI can be used to observe the mediastinum, especially the vascular structures, its usual value is limited ( 14 ). Both fexible and rigid bronchoscopy as a diagnostic tool can provide a real-time assessment of central airway obstruction. It is considered the gold standard in assessing morphology and degree of of central airway obstruction. It is of great importance to perform endobronchial biopsy to determine the pathological type, as this is an important factor when contemplating therapeutic intervention. Clinical heterogeneity in malignant central airway obstruction provides different opportunities to adapt and utilize endoscopic technology and tools. The rapid methods and tools for restoring airway patency include mechanical clearance, thermal tools, cryotherapy, and airway stenting. Delayed bronchoscopic methods, such as photodynamic therapy (PDT) and brachytherapy can also be used to establish airway patency in specific non-emergent situations ( 15 ). According to retrospective data regarding the success and complications of therapeutic interventions, the symptoms of malignant CAO can often be successfully palliated ( 16 ). Also, Assessment of risks and benefits of interventions in each individual patient during the decision-making process is the foundation stone. Given the rarity of the diagnosis, there is no standard treatment strategies for patients with primary tracheal lymphoma. The treatment strategy depends on the histology, clinical signs and symptoms, Severity of Airway Obstruction. Surgery, chemotherapy, and radiation therapy usually are used either alone or in combination. In patients with diffuse large cell lymphoma, the recommended treatment is a combination of intensive chemotherapy (similar to the CHOP regimen) and anti-CD20 antibody rituximab ( 17 ). In cases of bilateral or extra-lung lesions, recurrence or progression of pulmonary MALT lymphoma, chemotherapy alone is permitted. The effectiveness of CHOP and other multiple-agent chemotherapy treatment is not considered to be better than that of single-drug chemotherapy with cladribine or fludarabine (18.19). Anti-CD20 monoclonal antibodies (rituximab) are effective and can achieve a remission rate of 70% for MALT lymphoma irrespective of the disease site ( 20 ). In cases with bulky disease (defined as tumor mass > 10 cm in the largest diameter), radiaotherapy can be used as an adjunctive treatment for chemotherapy. It has been suggested that temporary tracheal stenting may be used for patients with tracheal lymphoma particularly when acute stabilization of the airway and urgent palliation of symptoms are necessary. It is followed by chemotherapy and/or radiotherapy, because primary tracheal lymphoma is usually sensitive to chemotherapy and radiotherapy and may be quickly controlled by lymphoma-specific treatment ( 21 ). Debulking surgery may still be the mainstay of initial treatment in cases of severe upper airway obstruction by endobronchial lymphoma, which promptly reduces the risk of asphyxia. The strategy can be a watch-andwait policy if the patient is asymptomatic In patients with BALT lymphoma ( 13 ). Although primary lymphomas originating from trachea generally appear to be associated with a favorable prognosis, which appears to depend on the histological type. The prognosis of patients with endobronchial lymphoma is significantly better than that of patients with aggressive lymphoma, with a complete response rate of 79% and a partial response rate of 21% ( 22 ). Conclusion Despite rarity, A high suspicion of endobronchial lymphoma is warranted when considering the differential diagnosis of central airway obstruction. It may present as an isolated central airway lesion by lymphoma without extrathoracic or extra-nodal manifestation. The prognosis of patients with isolated endobronchial lymphoma is better than that of aggressive lymphomas. Bronchoscopic examination with biopsy is essential to determine the pathological type, also both fexible and rigid bronchoscopy provide therapeutic intervention,including mechanical clearance, thermal tools, cryotherapy, and airway stenting. Declarations • Ethics approval and consent to participate: our patients gave written informed consent for his clinical details along with any identifying images to be published in this study. • Consent for publication:Informed consent was obtained from all individual participants included in the study. • Availability of data and materials: We would like to share our raw data. All data generated or analysed during this study are included in this published article. • Competing interests: None • Funding:This study was supported by grants from the National Natural Science Foundation of China (81270144, 30800507, and 81170071). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. • Authors' contributions:Literature search: Wei Zhou, Cai-li Li; Data collection: Mo CHEN, Cai-li Li; Study design: Cai-li Li, Jing Feng; Analysis of data: Shuo LI, Cai-li Li, Hai-yan ZHAO, Jing Feng; Manuscript preparation: Cai-li Li; Review of manuscript: Bao-yuan CHEN, Yubao WANG, Haiyan ZHAO, Jing Feng. • Acknowledgements: This study was supported by grants from the National Natural Science Foundation of China (81270144, 30800507, and 81170071). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. • Authors' information: Address correspondence to: Dr. Jing Feng Department of Respiratory, Tianjin Medical University General Hospital, Tianjin 300052, China. E-mail: [email protected] . References Ernst A, Feller-Kopman D, Becker HD, et al. Central airway obstruction. Am J Respir Crit Care Med 2004;169:1278-97. Oberg C, Folch E, Santacruz JF. Management of malignant airway obstruction. AME Med J 2018;3:115. Shin B, Chang B, Kim H, et al. Interventional bronchoscopy in malignant central airway obstruction by extra-pulmonary malignancy. BMC Pulm Med 2018;18:46. Murgu SD, Egressy K, Laxmanan B, et al. Central airway obstruction: benign strictures, tracheobronchomalacia, and malignancy-related obstruction. Chest . 2016;150(2):426-441. doi:10.1016/j.chest.2016.02.001. Tan DS, Eng PC, Lim ST, et al. Primary tracheal lymphoma causing respiratory failure. J Thorac Oncol 2008;3:929-30. Mukkamalla SKR, Winters R, Chandran AV. Tracheal Cancer. 2023 Jul 4. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. Berkman N, Breuer R, Kramer MR, Polliack A. Pulmonary involvement in lymphoma. Leuk Lymphoma 1996;20:229–237. Cadranel J, Wislez M, Antoine M. Primary pulmonary lymphoma. Eur Respir J 2002;20:750–762. Ferraro P, Trastek VF, Adlakha H, et al. Primary non-Hodgkin’s lymphoma of the lung. Ann Thorac Surg 2000;69:993–997. Cadranel J, Wislez M, Antoine M. Primary pulmonary lymphoma. Eur Respir J 2002;20:750–762. Cordier JF, Chailleux E, Lauque D, et al. Primary pulmonary lymphomas. A clinical study of 70 cases in non immuno-compromised patients. Chest1993; 103:201-8. Zinzani PL, Magagnoli M, Galieni P, et al. Nongastrointestinal low-grademucosa-associated lymphoid tissue lymphoma: analysis of 75 patients. J ClinOncol 1999;17:1254–8. Fung CY. Lymphoma of mucosa-associated lymphoid tissue. In: Stede GD, Philips TL, Chabner BA, editors. Malignant Lymphomas. Hamilton, London: BC Decker; 2002. pp 126–134. Fishman AP, Elias JA. Fishman’s pulmonary diseases and disorders. New Yrok: McGraw-Hill Medical; 2008. Mudambi L, Miller R, Eapen GA. Malignant central airway obstruction. J Thorac Dis. 2017 Sep;9(Suppl 10):S1087-S1110. Casal RF, Iribarren J, Eapen G, et al. Safety and effectiveness of microdebrider bronchoscopy for the management of central airway obstruction. Respirology 2013;18:1011-5. Solomonov A, Zuckerman T, Goralnik L, Ben-Arieh Y, Rowe JM, Yigla M. Non-Hodgkin's lymphoma presenting as an endobronchial tumor: report of eight cases and literature review. Am J Hematol. 2008 May;83(5):416-9. Borie R, Wislez M, Thabut G, et al. Clinical characteristics and prognostic factors of pulmonary MALT lymphoma. Eur Respir J 2009; 34: 1408–1416. Cordier JF, Chailleux E, Lauque D, et al. Primary pulmonary lymphomas. A clinical study of 70 cases in nonimmunocompromised patients. Chest 1993; 103: 201–208. Conconi A, Martinelli G, Thieblemont C, et al. Clinical activity of rituximab in extranodal marginal zone B-cell lymphoma of MALT type. Blood 2003; 102: 2741–2745. Dannenberg C, Haupt R, Mantovani L, Skuballa A, Korholz D. Primary high-grade non-Hodgkin lymphoma of the trachea in an adolescent. Pediatr Hematol Oncol. 2003;20:399-402. Cordier JF, Chailleux E, Lauque D, et al. Primary pulmonary lymphomas. A clinical study of 70 cases in nonimmunocompromised patients. Chest 1993; 103:201–208. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 15 Oct, 2025 Read the published version in BMC Pulmonary Medicine → Version 1 posted Editorial decision: Revision requested 26 May, 2025 Reviews received at journal 25 May, 2025 Reviewers agreed at journal 21 May, 2025 Reviewers agreed at journal 19 May, 2025 Reviewers agreed at journal 18 May, 2025 Reviewers agreed at journal 15 May, 2025 Reviewers agreed at journal 23 Apr, 2025 Reviews received at journal 22 Jan, 2025 Reviewers agreed at journal 22 Jan, 2025 Reviewers invited by journal 21 Jan, 2025 Editor invited by journal 20 Jan, 2025 Editor assigned by journal 17 Jan, 2025 Submission checks completed at journal 17 Jan, 2025 First submitted to journal 17 Dec, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5661329","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":403602458,"identity":"91eb8c83-1409-41c3-b533-104ef0b02758","order_by":0,"name":"Cai-li LI","email":"","orcid":"","institution":"Tianjin Medical University General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Cai-li","middleName":"","lastName":"LI","suffix":""},{"id":403602459,"identity":"9b1fd870-e6f9-4d1e-8f51-f75b3e7ae085","order_by":1,"name":"Wei ZHOU","email":"","orcid":"","institution":"Tianjin Medical University General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Wei","middleName":"","lastName":"ZHOU","suffix":""},{"id":403602460,"identity":"0cbe3137-8314-4912-8527-23eb0947db06","order_by":2,"name":"Mo CHEN","email":"","orcid":"","institution":"Tianjin Medical University General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Mo","middleName":"","lastName":"CHEN","suffix":""},{"id":403602461,"identity":"981d20ed-661c-40ed-b712-4dd201a7859c","order_by":3,"name":"Shuo LI","email":"","orcid":"","institution":"Tianjin Medical University General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Shuo","middleName":"","lastName":"LI","suffix":""},{"id":403602462,"identity":"9e6fe4c1-1799-4e8c-b71c-8a61aeecc3bc","order_by":4,"name":"Bao-yuan CHEN","email":"","orcid":"","institution":"Tianjin Medical University General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Bao-yuan","middleName":"","lastName":"CHEN","suffix":""},{"id":403602463,"identity":"c9a05d55-1fd8-4306-a535-31f558c9b91d","order_by":5,"name":"Yu-bao WANG","email":"","orcid":"","institution":"Tianjin Medical University General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yu-bao","middleName":"","lastName":"WANG","suffix":""},{"id":403602464,"identity":"d182c653-7491-43ed-8a54-95638d27faab","order_by":6,"name":"Hai-yan ZHAO","email":"","orcid":"","institution":"Tianjin Medical University General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Hai-yan","middleName":"","lastName":"ZHAO","suffix":""},{"id":403602465,"identity":"3b74ccc8-ea5c-4c17-ad50-11f341c1699c","order_by":7,"name":"Jing FENG","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABBklEQVRIie3PMUsDMRTA8RcOzuWVc8xh6X2FlEKLUKwfJXIgDhmcXA0UdCnOKS5+hE6dUwJ2Obw10KUiOKe4iNxgr7Rj046C+U9veD8eDyAU+pvFALpVD1wD9DE5kUeRzo5cN9ORPp7UmT6zl/79TInuBxas1Ute3s3tT4lggbiV2E+IEr22sqxzrpbcjJ8WSJ5llI6n+0lERZc6V11NrOamMVpg1NRx1PCQuCbcsfstecOYcj/BzRXLOCslN/itEQ8Rip93qSpYe2JhfUXmSHE29P6SPebTM3xlGSuL/Auri8FgPpy5lYfA6Q3b3hMcyEM9EenZX5fMl7tBA1T+5VAoFPqf/QJbpVn1577NZAAAAABJRU5ErkJggg==","orcid":"","institution":"Tianjin Medical University General Hospital","correspondingAuthor":true,"prefix":"","firstName":"Jing","middleName":"","lastName":"FENG","suffix":""}],"badges":[],"createdAt":"2024-12-17 11:38:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5661329/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5661329/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12890-025-03924-2","type":"published","date":"2025-10-15T15:57:08+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":74244494,"identity":"b298c56e-0d43-4a21-a2bb-dbd8744ccfb8","added_by":"auto","created_at":"2025-01-20 09:51:00","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":548089,"visible":true,"origin":"","legend":"\u003cp\u003eThe manifestation of pulmonary function test(PFT), chest computed tomography (CT), bronchoscopy and pathology. (A)PFT revealed \u0026nbsp;extremely severe obstruction of ventilation dysfunction. (B,C) CT of the chest revealed a soft tissue-density nodule within the trachea and thickened trachea wall(B, arrow shows the central bronchial stem), without enlarged lymph nodes compressing the trachea and main bronchus (C, arrow shows none enlarged lymph nodes); (D) bronchoscopic view of the trachea and carina showed significant soft mass that originated in the upper segment of the main bronchus; (E)Laser tumor ablation was used to achieve enucleation of the mass;(F) after interventional bronchoscopies, the main bronchi were rechanneled and some mucosal lesions remained; (G) pathological examination of the tumor showed lymphocyte proliferation was significant in mucosal interstitium; (H) a diffuse infiltrate of large pleomorphic lymphoid cells stained positively for CD20, indicating high grade B-cell non-Hodgkin’s lymphoma (magnification, ×400); (G) the Ki67 proliferation fraction was 15% (magnification, ×400).\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5661329/v1/b1dca6c339782a6fc7799a18.jpg"},{"id":74244496,"identity":"11d78806-6ec7-4872-88b4-bd4acfe044d7","added_by":"auto","created_at":"2025-01-20 09:51:00","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":2218790,"visible":true,"origin":"","legend":"\u003cp\u003eThe manifestation of chest computed tomography (CT), bronchoscopy and pathology. (A) CT of the chest revealed a soft tissue-density nodule in the posterior tracheal lumen;(B) bronchoscopic view of the trachea showed a significant soft mass at the upper trachea near the glottis, causing central airway obstruction. (C)The tumor was eliminated by laser ablation and biopsy forceps; (D) after interventional bronchoscopies, the main bronchi were rechanneled and much more clear than before; (G) pathological examination showed that mucosal interstitial lymphocyte proliferation was significant; (H) a diffuse infiltrate of large pleomorphic lymphoid cells stained positively for CD20, indicating B-cell lymphoma (magnification, ×400); (G) the Ki67 proliferation fraction was 15% (magnification, ×400).\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5661329/v1/3f025b7a3f6202c33704140a.jpg"},{"id":74244495,"identity":"ce9ce0a9-b1ea-4725-ab36-49f15e1a7d93","added_by":"auto","created_at":"2025-01-20 09:51:00","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":1172683,"visible":true,"origin":"","legend":"\u003cp\u003eThe manifestation of pulmonary function test(PFT), chest computed tomography (CT), bronchoscopy and pathology. (A)PFT showed a plateau-like change in expiratory phase,(B,C) CT of the chest showed thicken bronchial wall in a ring-like pattern. (D)bronchoscopic view of the trachea and carina revealed a significant soft mass that originated in the upper segment of the main bronchus. (E) A biopsy was performed via bronchoscope. (F)Pathological examination Revealed B cell lymphoma\u003c/p\u003e","description":"","filename":"Figure3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5661329/v1/f7180ecd1db28faeae3bcc4c.jpg"},{"id":93955917,"identity":"c1a6448b-9d40-4ad3-8804-ccca2823288b","added_by":"auto","created_at":"2025-10-20 16:06:37","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":4274027,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5661329/v1/b95e38e3-7b9e-41b2-a167-480a01fe70b0.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Severe Central Airway Obstruction Secondary to a Endobronchial Central Airway Obstruction Secondary to Primary B-cell Lymphoma With : three case reports and literature review","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCentral airway obstruction (CAO), an occlusion of more than 50% of the trachea, main stem bronchi, or lobar bronchus, may contribute to severe clinical symptoms and high mortality rate. It can be secondary to extrinsic compression from surrounding structures, direct extension from an adjacent tumor, metastatic disease and, less commonly primary intrinsic endobronchial malignancies(\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e) .The most common etiology is primarily bronchogenic carcinoma, with a percent of more than 50% of malignant CAO from non-small cell lung cancer as squamous cell carcinoma as previously mentioned(\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e). Small cell lung cancer may also directly invade the central airways causing obstruction from endobronchial involvement or cause central airway compression as a perihilar mass with lymphadenopathy(\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e). The same as thyroid, laryngeal, and esophageal malignancies. Nonmalignant causes of CAO are due to benign strictures related to post-intubation tracheal stenosis, autoimmune and infectious diseases (\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e). Although rare, primary tracheobronchial lymphoma presented as extranodal lymphoma may also cause airway obstruction (\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003ePrimary tracheobronchial lymphoma can cause respiratory failure (\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e), life-threatening airway obstruction, and lead to poorer prognosis. Here we report three cases of primary tracheobronchial B-cell Lymphoma in which the patients was suffering rare, obstruction of the central airway. To alleviate the airway obstruction, we performed interventional bronchoscopy involving laser tumor ablation. We present a literature review on primary tracheal lymphoma to enhance our understanding of the clinical features and management of this uncommon manifestation of lymphoma.\u003c/p\u003e"},{"header":"Case Presentation","content":"\u003cp\u003e \u003cstrong\u003eCase 1\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eA 78-year-old female was referred to our hospital with complaints of Cough with sputum for over a year, worsened with wheezing for 3 months. She received some cycles of antibiotics as lower respiratory tract infections with some beneficial effect before admission. The patient denied any headaches, stridor, and gastrointestinal or urinary symptoms. She denied a medical history of hypertension, diabetes, or asthma and denied medications or previous surgeries. She has a history of passive smoking.\u003c/p\u003e\u003cp\u003eThree months before admission, her dyspnea started worsening after exertion. However, she denied fever or other symptoms. The lung function test was completed, which showed extremely severe obstruction of ventilation dysfunction, slight decrease in diffusion function, and the normal range of residual volume/total lung capacity ratio(Figuer1A). The chest computed tomography(CT) scan revealed a soft tissue-density nodule within the trachea and thickened trachea wall. The nodule is closely attached to the left posterior wall, causing narrowing of the airway lumen. The secretions and mucus in the lumen of the trachea, the main bronchus on both sides were considered (Figuer 1B, 1C). She was referred to our hospital to confirm the diagnosis with a bronchoscopy under general anesthesia, which is a routine procedure.\u003c/p\u003e\u003cp\u003eThe physical examination evidenced a temperature, 37.1 ℃; respiration rate, 22 bpm; pulse, 72 bpm; blood pressure, 144/70 mmHg, and oxygen saturation in 92% with no oxygen supplementation. Breathing sounds were increased at the base of the right lung. No enlarged lymph nodes were detected. Blood gas analysis showed hypoxemia (pH 7.413; PaO2, 67.5 mmHg; PaCO2, 45 mmHg). Blood cell count was normal.\u003c/p\u003e\u003cp\u003eA bronchoscopy was performed and revealed a significant soft mass that originated in the upper segment of the main bronchus. The lesion was occluding the lumen of the main bronchus, which probably explained severe ventilation dysfunction in lung function. With the displacement of the lesion, ventilation of the main bronchus was achieved while the endoscopic resection was carried out. Laser tumor ablation was used to achieve enucleation of the mass (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eD-F). Pathological examination\u003c/p\u003e\u003cp\u003eRevealed mucosa- associated lymphoid tissue lymphoma of extra-nodal marginal zone B cells (MALT lymphoma)(Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eG), with diffuse sheets of large round cells staining positive for CD20、BCL2 and MLM1, and negative for CD3. The patient refused further PET-CT examination and treatment due to financial reasons.\u003c/p\u003e\n\u003ch3\u003eCase2\u003c/h3\u003e\n\u003cp\u003eA 69-year-old female was referred to our hospital with complaints of Cough and Cough with sputum intermittently for a month. The patient has been in good health in the past. She denied a medical history of hypertension, diabetes, or asthma and denied medications or previous surgeries. she denied exertional dyspnea, fever, or other symptoms. The lung function test was normal. The chest computed tomography(CT) scan revealed a soft tissue-density nodule in the posterior tracheal lumen, causing narrowing of the airway lumen. The lesion appeared heterogeneous with a maximum cross-sectional area of 14mm*9mm and unclear demarcation with the esophagus(Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eA ). She was referred to our hospital to confirm the diagnosis with a bronchoscopy.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe physical examination evidenced a temperature, 36.5 ℃; respiration rate, 29 bpm; pulse, 78 bpm; blood pressure, 114/67 mmHg, and oxygen saturation in 96% with no oxygen supplementation. Breathing sounds were normal. No enlarged lymph nodes were detected. Blood cell count was normal.\u003c/p\u003e \u003cp\u003eA bronchoscopy was performed and revealed a significant soft mass at the upper trachea near the glottis, causing central airway obstruction. The tumor was eliminated by laser ablation and biopsy forceps, inducing the trachea much more clear than before (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Pathological examination revealed that lymphatic system malignant diseases are not excluded(Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eC), with diffuse sheets of large round cells staining positive for CD20、BCL2, and partial positive for CD3 in our hospital. The pathological consultation at an outpatient oncology specialty hospital has MALT lymphoma.This patient was transferred to the hematology department for further chemotherapy.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eCase3\u003c/h2\u003e \u003cp\u003eA 47-year-old male was referred to our hospital with complaints of Cough with sputum for 2 months. He denied a medical history of hypertension, diabetes, or asthma and denied medications or previous surgeries. He did not has a history of smoking.\u003c/p\u003e \u003cp\u003eTwo months before admission, his dyspnea started worsening after exertion. The lung function test was completed in outpatient department, which showed a plateau-like change in expiratory phase, with a mild reduction in diffusion function (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eA). The chest computed tomography(CT) scan revealed thickened trachea wall in Right anterior with ring-like enhancement (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eB ). He was referred to our hospital to confirm the diagnosis with a bronchoscopy. The physical examination evidenced a temperature, 36.4 ℃; respiration rate, 18 bpm; pulse, 86 bpm; blood pressure, 136/73 mmHg, and oxygen saturation in 96% with no oxygen supplementation. Breathing sounds were normal. No enlarged lymph nodes were detected.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe chest computed tomography(CT) scan revealed thicken bronchial wall in a ring-like pattern. A bronchoscopy was performed and revealed a significant soft mass that originated in the upper segment of the main bronchus. The lesion was occluding the lumen of the main bronchus, which probably explained severe ventilation dysfunction in lung function. A biopsy was performed via bronchoscope (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eD-E). Pathological examination Revealed B cell lymphoma (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eF), with CD20 positive for B cells distributed in patches; CD3, CD5, CD7 slightly more positive for T cells.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003ePrimary neoplasms of the trachea are rare, comprising only 0.2% of all malignancies (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Furthermore, primary tracheal non-Hodgkin\u0026rsquo;s lymphoma accounts for only 0.2\u0026ndash;3% of all tracheal tumors (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Extra-nodal lymphoma itself is not uncommon, but the rate of extranodal lymphoma involving tracheal bronchial is only 3.6% (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Although Various histological subtypes of primary tracheal lymphoma exist, the most common types are mucosa-associated lymphoid tissue (MALT) lymphoma(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e), and diffuse B-cell lymphomas(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). This low grade malignancy of MALT lymphomas has a tendency to remain localised to the primary site and to respond favourably to local treatments such as surgery and/or radiotherapy, with more favourable outcome and prognosis than for other extra-nodal lymphomas reported in the literature (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). B cell lymphomas were also described but are less common (20\u0026ndash; 25% of primary pulmonary lymphoma) (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). As in our case, two cases were MALT lymphoma and one case was B-cell lymphoma.\u003c/p\u003e \u003cp\u003eEndobronchial lymphoma is classified into two types depends on the pattern of involvement. Type I includes diffuse submucosal infiltration caused by systemic lymphoma, which can be caused by hematogenous or lymphatic dissemination. Type II (similar to our patients) includes airway involvement caused by local tumors originating from adjacent lymph nodes or directly from bronchial-associated lymphoid tissue. Type II lesions were associated with respiratory obstruction symptoms such as cough or wheezing in all cases, as demonstrated by our patients.\u003c/p\u003e \u003cp\u003eThe most common symptoms are dyspnea, cough and wheezing, which are non-specific. It was initially misdiagnosed as bronchial asthma due to the presence of symptoms and signs. But clinical manifestations depend on the severity of central airway obstruction. Patients with mild tracheal stenosis (stenosis less than 50%) are often asymptomatic. Moderate occlusions that present an airway obstruction between 51% and 70% of the lumen may present with cough, hemoptysis, shortness of breath, chest pain, wheezing, and recurrent pneumonia or atelectasis. Moderate occlusions can cause airway narrowing by 51\u0026ndash;70%, and patients may experience symptoms such as coughing, hemoptysis, dyspnea, chest pain, wheezing, and recurrent pneumonia or atelectasis.Whereas in patients who present with acute respiratory failure, severe stenosis (\u0026gt;\u0026thinsp;70%) must be suspected, which should be taken with immediate procedure to eliminate the airway obstruction and maintain the adequate ventilation.\u003c/p\u003e \u003cp\u003eCT with tracheal protocols is the procedure of choice for accurate estimations of lesion length, degree of airway narrowing, patency of the distal airway, anatomic relationships to structures surrounding the airways 10. Thin slices can be used for 3-D reconstruction, which is particularly useful for preoperative analysis for the airways in respect to surrounding structures and a virtual bronchoscopic evaluation. Dynamic CT is effective for the diagnosis of TBM. Although MRI can be used to observe the mediastinum, especially the vascular structures, its usual value is limited (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eBoth fexible and rigid bronchoscopy as a diagnostic tool can provide a real-time assessment of central airway obstruction. It is considered the gold standard in assessing morphology and degree of of central airway obstruction. It is of great importance to perform endobronchial biopsy to determine the pathological type, as this is an important factor when contemplating therapeutic intervention. Clinical heterogeneity in malignant central airway obstruction provides different opportunities to adapt and utilize endoscopic technology and tools. The rapid methods and tools for restoring airway patency include mechanical clearance, thermal tools, cryotherapy, and airway stenting. Delayed bronchoscopic methods, such as photodynamic therapy (PDT) and brachytherapy can also be used to establish airway patency in specific non-emergent situations (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). According to retrospective data regarding the success and complications of therapeutic interventions, the symptoms of malignant CAO can often be successfully palliated (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Also, Assessment of risks and benefits of interventions in each individual patient during the decision-making process is the foundation stone.\u003c/p\u003e \u003cp\u003eGiven the rarity of the diagnosis, there is no standard treatment strategies for patients with primary tracheal lymphoma. The treatment strategy depends on the histology, clinical signs and symptoms, Severity of Airway Obstruction. Surgery, chemotherapy, and radiation therapy usually are used either alone or in combination. In patients with diffuse large cell lymphoma, the recommended treatment is a combination of intensive chemotherapy (similar to the CHOP regimen) and anti-CD20 antibody rituximab (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). In cases of bilateral or extra-lung lesions, recurrence or progression of pulmonary MALT lymphoma, chemotherapy alone is permitted. The effectiveness of CHOP and other multiple-agent chemotherapy treatment is not considered to be better than that of single-drug chemotherapy with cladribine or fludarabine (18.19). Anti-CD20 monoclonal antibodies (rituximab) are effective and can achieve a remission rate of 70% for MALT lymphoma irrespective of the disease site (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). In cases with bulky disease (defined as tumor mass\u0026thinsp;\u0026gt;\u0026thinsp;10 cm in the largest diameter), radiaotherapy can be used as an adjunctive treatment for chemotherapy. It has been suggested that temporary tracheal stenting may be used for patients with tracheal lymphoma particularly when acute stabilization of the airway and urgent palliation of symptoms are necessary. It is followed by chemotherapy and/or radiotherapy, because primary tracheal lymphoma is usually sensitive to chemotherapy and radiotherapy and may be quickly controlled by lymphoma-specific treatment (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Debulking surgery may still be the mainstay of initial treatment in cases of severe upper airway obstruction by endobronchial lymphoma, which promptly reduces the risk of asphyxia. The strategy can be a watch-andwait policy if the patient is asymptomatic In patients with BALT lymphoma (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAlthough primary lymphomas originating from trachea generally appear to be associated with a favorable prognosis, which appears to depend on the histological type. The prognosis of patients with endobronchial lymphoma is significantly better than that of patients with aggressive lymphoma, with a complete response rate of 79% and a partial response rate of 21% (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eDespite rarity, A high suspicion of endobronchial lymphoma is warranted when considering the differential diagnosis of central airway obstruction. It may present as an isolated central airway lesion by lymphoma without extrathoracic or extra-nodal manifestation. The prognosis of patients with isolated endobronchial lymphoma is better than that of aggressive lymphomas. Bronchoscopic examination with biopsy is essential to determine the pathological type, also both fexible and rigid bronchoscopy provide therapeutic intervention,including mechanical clearance, thermal tools, cryotherapy, and airway stenting.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u0026bull; Ethics approval and consent to participate: our patients gave written informed consent for his clinical details along with any identifying images to be published in this study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026bull; Consent for publication:Informed consent was obtained from all individual participants included in the study.\u003c/p\u003e\n\u003cp\u003e\u0026bull; Availability of data and materials: We would like to share our raw data. All data generated or analysed during this study are included in this published article.\u003c/p\u003e\n\u003cp\u003e\u0026bull; Competing interests: None\u003c/p\u003e\n\u003cp\u003e\u0026bull; Funding:This study was supported by grants from the National Natural\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eScience Foundation of China (81270144, 30800507, and 81170071). The funders had no role in study design, data collection and analysis,\u0026nbsp;decision to publish, or preparation of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u0026bull; Authors\u0026apos; contributions:Literature search: Wei Zhou, Cai-li Li; Data collection: Mo CHEN, Cai-li Li; Study design: Cai-li Li, Jing Feng; Analysis of data: Shuo LI, Cai-li Li, Hai-yan ZHAO, Jing Feng; Manuscript preparation: Cai-li Li; Review of manuscript: Bao-yuan CHEN, Yubao WANG, Haiyan ZHAO, Jing Feng.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026bull; Acknowledgements:\u0026nbsp;This study was supported by grants from the National Natural\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eScience Foundation of China (81270144, 30800507, and 81170071). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u0026bull; Authors\u0026apos; information: Address correspondence to: Dr. Jing Feng Department of Respiratory, Tianjin Medical University General Hospital, Tianjin 300052, China. E-mail: [email protected].\u003c/p\u003e\n"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eErnst A, Feller-Kopman D, Becker HD, et al. Central airway obstruction. Am J Respir Crit Care Med 2004;169:1278-97.\u003c/li\u003e\n\u003cli\u003eOberg C, Folch E, Santacruz JF. Management of malignant airway obstruction. AME Med J 2018;3:115. \u003c/li\u003e\n\u003cli\u003eShin B, Chang B, Kim H, et al. Interventional bronchoscopy in malignant central airway obstruction by extra-pulmonary malignancy. BMC Pulm Med 2018;18:46.\u003c/li\u003e\n\u003cli\u003eMurgu SD, Egressy K, Laxmanan B, et al. Central airway obstruction: benign strictures, tracheobronchomalacia, and malignancy-related obstruction. \u003cem\u003eChest\u003c/em\u003e. 2016;150(2):426-441. doi:10.1016/j.chest.2016.02.001.\u003c/li\u003e\n\u003cli\u003eTan DS, Eng PC, Lim ST, et al. Primary tracheal lymphoma causing respiratory failure. J Thorac Oncol 2008;3:929-30. \u003c/li\u003e\n\u003cli\u003eMukkamalla SKR, Winters R, Chandran AV. Tracheal Cancer. 2023 Jul 4. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan\u0026ndash;.\u003c/li\u003e\n\u003cli\u003eBerkman N, Breuer R, Kramer MR, Polliack A. Pulmonary involvement in lymphoma. Leuk Lymphoma 1996;20:229\u0026ndash;237. \u003c/li\u003e\n\u003cli\u003eCadranel J, Wislez M, Antoine M. Primary pulmonary lymphoma. Eur Respir J 2002;20:750\u0026ndash;762. \u003c/li\u003e\n\u003cli\u003eFerraro P, Trastek VF, Adlakha H, et al. Primary non-Hodgkin\u0026rsquo;s lymphoma of the lung. Ann Thorac Surg 2000;69:993\u0026ndash;997.\u003c/li\u003e\n\u003cli\u003eCadranel J, Wislez M, Antoine M. Primary pulmonary lymphoma. Eur Respir J 2002;20:750\u0026ndash;762.\u003c/li\u003e\n\u003cli\u003eCordier JF, Chailleux E, Lauque D, et al. Primary pulmonary lymphomas. A clinical study of 70 cases in non immuno-compromised patients. Chest1993; 103:201-8.\u003c/li\u003e\n\u003cli\u003eZinzani PL, Magagnoli M, Galieni P, et al. Nongastrointestinal low-grademucosa-associated lymphoid tissue lymphoma: analysis of 75 patients. J ClinOncol 1999;17:1254\u0026ndash;8.\u003c/li\u003e\n\u003cli\u003eFung CY. Lymphoma of mucosa-associated lymphoid tissue. In: Stede GD, Philips TL, Chabner BA, editors. Malignant Lymphomas. Hamilton, London: BC Decker; 2002. pp 126\u0026ndash;134.\u003c/li\u003e\n\u003cli\u003eFishman AP, Elias JA. Fishman\u0026rsquo;s pulmonary diseases and disorders. New Yrok: McGraw-Hill Medical; 2008.\u003c/li\u003e\n\u003cli\u003eMudambi L, Miller R, Eapen GA. Malignant central airway obstruction. J Thorac Dis. 2017 Sep;9(Suppl 10):S1087-S1110. \u003c/li\u003e\n\u003cli\u003eCasal RF, Iribarren J, Eapen G, et al. Safety and effectiveness of microdebrider bronchoscopy for the management of central airway obstruction. Respirology 2013;18:1011-5.\u003c/li\u003e\n\u003cli\u003eSolomonov A, Zuckerman T, Goralnik L, Ben-Arieh Y, Rowe JM, Yigla M. Non-Hodgkin\u0026apos;s lymphoma presenting as an endobronchial tumor: report of eight cases and literature review. Am J Hematol. 2008 May;83(5):416-9. \u003c/li\u003e\n\u003cli\u003eBorie R, Wislez M, Thabut G, et al. Clinical characteristics and prognostic factors of pulmonary MALT lymphoma. Eur Respir J 2009; 34: 1408\u0026ndash;1416.\u003c/li\u003e\n\u003cli\u003eCordier JF, Chailleux E, Lauque D, et al. Primary pulmonary lymphomas. A clinical study of 70 cases in nonimmunocompromised patients. Chest 1993; 103: 201\u0026ndash;208.\u003c/li\u003e\n\u003cli\u003eConconi A, Martinelli G, Thieblemont C, et al. Clinical activity of rituximab in extranodal marginal zone B-cell lymphoma of MALT type. Blood 2003; 102: 2741\u0026ndash;2745.\u003c/li\u003e\n\u003cli\u003eDannenberg C, Haupt R, Mantovani L, Skuballa A, Korholz D. Primary high-grade non-Hodgkin lymphoma of the trachea in an adolescent. \u003cem\u003ePediatr Hematol Oncol. \u003c/em\u003e2003;20:399-402.\u003c/li\u003e\n\u003cli\u003eCordier JF, Chailleux E, Lauque D, et al. Primary pulmonary lymphomas. A clinical study of 70 cases in nonimmunocompromised patients. Chest 1993; 103:201\u0026ndash;208. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pulmonary-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pulm","sideBox":"Learn more about [BMC Pulmonary Medicine](http://bmcpulmmed.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pulm/default.aspx","title":"BMC Pulmonary Medicine","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Primary B-cell Lymphoma, central airway obstruction, Extranodal, Tracheal stenosis","lastPublishedDoi":"10.21203/rs.3.rs-5661329/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5661329/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eCentral airway obstruction can be secondary to extrinsic compression from surrounding structures, direct extension from an adjacent tumor, metastatic disease and, less commonly primary intrinsic endobronchial malignancies.To our knowledge, nearly few reports of an isolated central airway lesion by primary lymphoma without extrathoracic or extra-nodal manifestation have been published to date. This is the first case about malignant trachea obstruction caused by primary B-cell lymphoma without involvement of the main stem bronchi, lobar bronchus and mediastinum. Cases presentation: The three patients were admitted to hospital for coughing accompanied by wheezing that recent exacerbated. The chest computed tomography scan revealed a soft tissue-density mass within the central trachea. Pathological analysis showed that these were lymphoma. No enlarged mediastinal or cervical lymph nodes were found.. Conclusion: A high suspicion of endobronchial lymphoma is warranted in the differential diagnosis of a pathological mass located in central airway.\u003c/p\u003e","manuscriptTitle":"Severe Central Airway Obstruction Secondary to a Endobronchial Central Airway Obstruction Secondary to Primary B-cell Lymphoma With : three case reports and literature review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-20 09:50:55","doi":"10.21203/rs.3.rs-5661329/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-05-26T11:19:12+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-25T13:19:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"65441524568561109549420031593982515162","date":"2025-05-21T09:20:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"330102153986345504812383115708050550815","date":"2025-05-19T14:31:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"108424190134747284554615884404886408329","date":"2025-05-18T22:27:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"25828277446225564188234386104377149468","date":"2025-05-15T09:28:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"69943534133057699872311547547990986513","date":"2025-04-23T21:00:54+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-01-22T15:15:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"214816407087459150649591969347180280489","date":"2025-01-22T13:51:32+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-01-21T19:33:28+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-01-20T12:05:17+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-01-17T15:20:11+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-01-17T15:17:49+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pulmonary Medicine","date":"2024-12-17T11:27:21+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pulmonary-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pulm","sideBox":"Learn more about [BMC Pulmonary Medicine](http://bmcpulmmed.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pulm/default.aspx","title":"BMC Pulmonary Medicine","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"29a4afc2-8829-4297-979e-e1079d0c7560","owner":[],"postedDate":"January 20th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-10-20T15:59:48+00:00","versionOfRecord":{"articleIdentity":"rs-5661329","link":"https://doi.org/10.1186/s12890-025-03924-2","journal":{"identity":"bmc-pulmonary-medicine","isVorOnly":false,"title":"BMC Pulmonary Medicine"},"publishedOn":"2025-10-15 15:57:08","publishedOnDateReadable":"October 15th, 2025"},"versionCreatedAt":"2025-01-20 09:50:55","video":"","vorDoi":"10.1186/s12890-025-03924-2","vorDoiUrl":"https://doi.org/10.1186/s12890-025-03924-2","workflowStages":[]},"version":"v1","identity":"rs-5661329","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5661329","identity":"rs-5661329","version":["v1"]},"buildId":"YNXEClSfUDGFtmkgMcPST","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}