Interventional bronchoscopy for diagnosis and airway recanalization in a child with endobronchial diffuse large B-cell lymphoma

Abstract

Endobronchial involvement by diffuse large B-cell lymphoma (DLBCL) is rare in children, particularly in the setting of Epstein–Barr virus (EBV)-associated lymphoproliferation. We report an 8-year-old girl with a previous clinical diagnosis of chronic active Epstein–Barr virus infection and hemophagocytic lymphohistiocytosis who was readmitted with paronychia and fever. Imaging showed an obstructing mass in the right main bronchus with atelectasis, together with widespread lymphadenopathy and hepatic lesions. An initial ultrasound-guided fine-needle biopsy of a right cervical lymph node showed EBV-associated lymphoid hyperplasia without definite lymphoma. During the subsequent admission, a newly identified left submandibular mass was sampled by ultrasound-guided core-needle biopsy. However, no finalized pathological diagnosis was available when the airway obstruction progressed. Interventional bronchoscopy was therefore undertaken under general anesthesia to obtain bronchial tissue and improve airway patency. The mass was partially removed using electrosurgical snaring and cryo-extraction, followed by argon plasma coagulation for hemostasis. Preliminary assessment of the bronchial tissue and flow cytometry supported B-cell lymphoma, and systemic treatment was initiated on 5 June 2026. Final written pathology reports for both the submandibular and bronchial specimens, issued on 10 June, supported EBV-positive DLBCL with polymorphic morphology. Chest CT on 16 June showed improved aeration of the right lung and a patent right main bronchus. At the 16-day follow-up, the patient remained on treatment without recurrent dyspnea, hypoxemia, or a need for supplemental oxygen. In this patient, interventional bronchoscopy provided additional tissue while the lymph-node specimen was under evaluation and partially restored airway patency.