Tracheal Stent Placement Successfully Relieves Severe Respiratory Distress Caused by MALT Lymphoma

When a 65-year-old male presented with life-disrupting shortness of breath, doctors at the Third Affiliated Hospital of Sun Yat-sen University uncovered a rare but treatable cause: extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) compressing the trachea. Advanced imaging revealed significant airway obstruction due to a growing mass along the tracheal wall, leading to critical narrowing of the windpipe and main bronchi. Immediate intervention was required to prevent respiratory failure.

This case highlights how timely diagnosis and minimally invasive surgical treatment can dramatically improve patient outcomes—even in complex oncological scenarios. With a tailored approach that prioritized symptom relief over aggressive therapy, the patient experienced rapid recovery and has since resumed normal daily activities without complications.

Understanding the Diagnosis: What Is MALT Lymphoma?

MALT lymphoma, or mucosa-associated lymphoid tissue lymphoma, is a subtype of non-Hodgkin's lymphoma that typically arises in tissues outside the lymph nodes, often linked to chronic inflammation or autoimmune conditions. While commonly found in the stomach—frequently associated with H. pylori infection—it can also develop in other organs, including the lungs, salivary glands, thyroid, and, as seen in this case, the respiratory tract.

In this instance, the tumor developed beneath the mucosal lining of the trachea, causing progressive compression of the airway. Because symptoms mimic those of asthma or chronic bronchitis, such cases are often misdiagnosed initially. However, when standard treatments fail and breathing difficulties worsen, further investigation with CT scans and bronchoscopy becomes essential for accurate diagnosis.

The Role of Imaging and Biopsy in Confirming the Condition

Chest computed tomography (CT) played a crucial role in identifying the true nature of the problem. The scan showed a large, circumferential lesion partially obstructing the trachea, along with external compression on the esophagus and enlarged mediastinal lymph nodes. These findings ruled out common pulmonary diseases and pointed toward a structural or neoplastic cause.

To confirm the diagnosis, a biopsy was performed during stent placement using bronchoscopic guidance. Histopathological analysis of the collected tissue confirmed the presence of extranodal marginal zone B-cell lymphoma of MALT type. This low-grade, slow-growing cancer allowed clinicians to adopt a conservative management strategy focused on monitoring rather than immediate chemotherapy or radiation.

Why Surgery Was Chosen Over Chemotherapy

Given the severity of tracheal narrowing—resulting in an arterial oxygen pressure (PaO₂) of just 60 mmHg—the priority was immediate airway stabilization. Without intervention, the patient faced high risks of mucus plugging, acute respiratory distress, and potential fatality.

Complete surgical resection was not feasible due to the extensive submucosal spread of the tumor. Instead, a tracheal stent placement procedure was selected. This endoscopic technique offers several advantages:

• Rapid restoration of airflow
• Minimal invasiveness compared to open surgery
• Low complication rate
• Compatibility with future systemic therapies if needed

The procedure was conducted under local anesthesia with sedation, allowing real-time assessment of airway dynamics. A self-expanding metallic stent was precisely positioned across the narrowed segment, instantly improving ventilation. Tissue samples were safely obtained during the same session for definitive pathological evaluation.

Supportive Care During Hospitalization

Post-procedure, the patient received intravenous antibiotics (ceftriaxone sodium) to prevent infection and bromhexine hydrochloride injection to thin secretions and support mucociliary clearance—an important consideration given that stents may impair natural airway defense mechanisms.

He remained hospitalized for one week under close observation. Oxygen supplementation continued until stable spontaneous breathing was achieved. Follow-up imaging confirmed proper stent positioning and absence of pneumonia or pneumothorax, clearing the way for discharge.

Outcomes and Recovery Timeline

The results were remarkable. Within 24 hours of the procedure, the patient reported significantly improved breathing. By day two, he was walking unassisted. One week later, a repeat chest CT showed no stent migration or signs of lung infection. His energy levels returned, and he resumed basic self-care tasks independently.

At the one-month follow-up visit, he exhibited no symptoms of dyspnea or coughing. Another CT scan confirmed sustained patency of the airway and stable disease status. Today, more than three years post-treatment, the patient remains asymptomatic and fully functional, living a near-normal life with regular surveillance.

Long-Term Monitoring Recommendations

Because MALT lymphoma tends to progress slowly, especially in early-stage presentations, active surveillance is often appropriate—particularly in older adults who may not tolerate intensive therapies well. For this patient, the following precautions and monitoring schedule were advised:

1. Immediate medical attention if new or worsening symptoms arise—especially increased shortness of breath, persistent cough, or production of thick or discolored sputum.
2. Vigilance for secondary infections: Tracheal stents can disrupt ciliary function, increasing susceptibility to bacterial colonization. Yellow or green phlegm should prompt urgent evaluation for possible respiratory infection.
3. Scheduled imaging every six months: Regular chest CT scans help track both tumor behavior and stent integrity, ensuring early detection of any changes.

Clinical Insights and Preventive Awareness

This case underscores a vital message: persistent respiratory symptoms should never be dismissed as simple asthma or aging-related decline. Misdiagnosis delays effective care and can lead to life-threatening complications. When conventional treatments fail, advanced diagnostics like CT scanning and bronchoscopy are indispensable tools.

MALT lymphomas, though rare in the trachea, must be considered in patients with unexplained airway narrowing. Their indolent nature allows for individualized treatment plans—balancing quality of life with disease control.

Early intervention saves lives. Had this patient waited longer, he might have succumbed to airway occlusion. Instead, timely access to specialized care transformed his prognosis from critical to stable. It's a powerful reminder that seeking expert evaluation at the first sign of abnormal health changes can make all the difference.