Besteiro Bruno, Teixeira Carina, Gullo Irene, Pereira Sofia, Almeida Miguel, Almeida Jorge
Internal Medicine Department, Centro Hospitalar e Universitário de São João, Oporto, Portugal.
Faculty of Medicine, Oporto University, Centro Hospitalar e Universitário de São João, Oporto, Portugal. Medicine Department.
Radiol Case Rep. 2021 Feb 11;16(4):929-933. doi: 10.1016/j.radcr.2021.01.063. eCollection 2021 Apr.
The superior vena cava syndrome refers to a medical emergency resulting from superior vena cava compression, which develops in 2%-4% of non-Hodgkin lymphomas. Primary mediastinal (thymic) large B-cell lymphoma is an unusual and aggressive non-Hodgkin lymphoma that can present with superior vena cava syndrome. We report the case of a Caucasian 21-year-old female, who presented with acute superior vena cava syndrome, having started 2 weeks before. Chest computerized tomography disclosed an anterior mediastinal mass (18 × 14 cm). Thoracoabdominopelvic magnetic resonance imaging was performed in order to differentiate compression versus mass invasion. A gross anterior mediastinal mass (109 × 60 × 105 mm) occupying the totality of the prevascular space was found, extending from the sternal furcula to the pericardium, fully embedding the superior vena cava. A computerized tomography guided biopsy was performed. Histopathological and immunohistochemical analysis was consistent with Primary mediastinal (thymic) large B-cell lymphoma. Primary mediastinal (thymic) large B-cell lymphoma has unique clinicopathologic aspects and it should be considered in a young patient with Superior vena cava syndrome. Prompt recognition, a timely diagnosis and appropriate treatment are crucial for prognosis.
上腔静脉综合征是指由上腔静脉受压引起的一种医疗急症，在2%-4%的非霍奇金淋巴瘤患者中会出现。原发性纵隔（胸腺）大B细胞淋巴瘤是一种罕见且侵袭性强的非霍奇金淋巴瘤，可表现为上腔静脉综合征。我们报告了一例21岁的白种女性病例，她在2周前开始出现急性上腔静脉综合征。胸部计算机断层扫描显示前纵隔有一个肿块（18×14厘米）。进行了胸腹部盆腔磁共振成像以区分压迫与肿块侵犯。发现一个巨大的前纵隔肿块（109×60×105毫米）占据了血管前间隙的全部，从胸骨柄延伸至心包，完全包绕上腔静脉。进行了计算机断层扫描引导下的活检。组织病理学和免疫组织化学分析与原发性纵隔（胸腺）大B细胞淋巴瘤一致。原发性纵隔（胸腺）大B细胞淋巴瘤具有独特的临床病理特征，对于患有上腔静脉综合征的年轻患者应予以考虑。及时识别、及时诊断和适当治疗对预后至关重要。
