Title: Large B-Cell Lymphoma Presenting as Anterior Mediastinal Mass in a 24-Year-Old Female
Author(s): Stanley Ozogbo, MD; Stephen Pupillo, DO; Kwabena Owusu-Ansah, MD
Email: sozogbo@mercy.com
Introduction: Large B-cell lymphoma is a common subtype of non-Hodgkin lymphoma that typically presents as a rapidly growing mass in lymph nodes. However, its occurrence as an anterior mediastinal mass is unusual. This case report aims to describe the clinical characteristics, diagnostic challenges, treatment modalities, and overall management of this unique presentation of large B-cell lymphoma.
Case Presentation: A 24-year-old female presented to the emergency department with a two-month history of progressively worsening chest pain. She described the pain as intermittent, sharp, and localized to the left side of her chest, exacerbated by deep inspiration with associated dyspnea and dysphagia. The patient denied any associated palpitations, epigastric burning pain, muscle weakness, headache, cough, and fever. She had no significant past medical history, including no history of smoking, alcohol use or exposure to environmental toxins. Upon physical examination, the patient appeared well and in no acute distress. Lung auscultation revealed normal breath sounds bilaterally, and cardiovascular examination was unremarkable. Initial investigations, including complete blood count, basic metabolic panel, and electrocardiogram, were within normal limits. Chest x-ray showed bilateral hilar fullness indicating a mediastinal mass. Computed tomography (CT) scan of the chest revealed a large anterior mediastinal mass measuring 7.9 cm in diameter, causing compression on adjacent structures. She had CT-guided core needle biopsy of the anterior mediastinal mass with histopathological examination diffuse infiltrate of large atypical lymphoid cells with prominent nucleoli and abundant cytoplasm, consistent with large B-cell lymphoma. Immunophenotyping confirmed the neoplastic cells were positive for CD19 and CD20, supporting the diagnosis. She underwent six cycles of chemotherapy with R-EPOCH regimen (etoposide, prednisone, vincristine, cyclophosphamide and doxorubicin). The patient tolerated chemotherapy well, experiencing mild sensory neuropathy. Positron emission tomography scan demonstrated residual soft tissue density in the anterior mediastinum and pericardial regions with minimal fluorodeoxyglucose (FDG) update likely representing scarring, residual thymus tissue. Regular follow-up examinations, including imaging and clinical assessments, have shown no evidence of disease recurrence to date.
Discussion: The purpose of this report is to contribute to the literature on this rare presentation of anterior mediastinal lymphoma, highlighting the importance of early diagnosis and appropriate management in achieving favorable patient outcomes. Anterior mediastinal masses in young patients are often attributed to thymomas, germ cell tumors, or lymphomas. In this case, the diagnosis of large B-cell lymphoma was challenging due to the rarity of the presentation and the need for accurate histopathological examination and immunophenotyping. The patient’s excellent response to R-EPOCH therapy aligns with the favorable outcomes reported in large B-cell lymphoma cases.
Conclusion: This case report emphasizes the importance of considering large B-cell lymphoma as a differential diagnosis when evaluating anterior mediastinal masses in young patients. Early diagnosis, accurate histopathological examination, and appropriate treatment initiation, such as R-EPOCH chemotherapy, can lead to favorable outcomes and improved patient survival rates. Further research and case reports will contribute to a better understanding of this rare presentation and its optimal management.
