Gastroenterology Department, Centro Hospitalar e Universitário Coimbra, Coimbra, Portugal
Gastroenterology Department, Portuguese Oncology Institute of Coimbra, Coimbra, Portugal.
BMJ Case Rep. 2021 Dec 31;14(12):e246791. doi: 10.1136/bcr-2021-246791.
An 18-year-old woman presented with progressive oesophageal dysphagia, weight loss and night sweats over a 6-month period. Oesophagogastroduodenoscopy revealed a diffuse luminal narrowing with normal mucosa, whose biopsies were inconclusive. A cervical and thoracic CT scan showed a thickening of the upper oesophagus, densification of the mediastinal fat, several adenopathies and a 4.3×2.4 cm mass with infiltrative appearance and heterogeneous enhancement in right cervical paravertebral location. Positron emission tomography-CT showed marked increased fluorodeoxyglucose uptake in supradiaphragmatic lymph nodes, pleuropulmonary tissue, paraspinal musculature and bone marrow. Imaging-guided and surgical incisional biopsies of the paravertebral mass were inconclusive. During hospitalisation, she developed right cervicobrachial paraesthesia. Only excisional biopsy of the mass allowed the diagnosis of high-grade B-cell lymphoma not otherwise specified, Ann Arbor stage IV-B. The patient underwent chemotherapy with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone), followed by R-EPOCH (rituximab, etoposide, prednisone, vincristine, cyclophosphamide and doxorubicin hydrochloride). Follow-up at 12 months revealed complete response.
一位 18 岁女性，因进行性食管吞咽困难、体重减轻和盗汗，于 6 个月来院就诊。上消化道内镜检查发现弥漫性管腔狭窄，伴正常黏膜，活检结果不明确。颈部和胸部 CT 扫描显示食管上段增厚，纵隔脂肪致密，纵隔多个淋巴结肿大，右侧颈旁椎旁有一个 4.3×2.4cm 的肿块，呈浸润性外观，不均匀强化。正电子发射断层扫描-CT 显示膈上淋巴结、胸膜肺组织、椎旁肌肉和骨髓摄取氟脱氧葡萄糖明显增加。经影像学引导和手术切开活检，椎旁肿块的活检结果仍不明确。住院期间，患者出现右侧颈臂感觉异常。只有切除椎旁肿块的活检才能明确诊断为非特指性高级别 B 细胞淋巴瘤，Ann Arbor 分期为 IV-B 期。患者接受了 R-CHOP（利妥昔单抗、环磷酰胺、多柔比星、长春新碱和泼尼松）化疗，随后进行了 R-EPOCH（利妥昔单抗、依托泊苷、泼尼松、长春新碱、环磷酰胺和盐酸多柔比星）化疗。12 个月随访时发现完全缓解。
