Department of Internal Medicine, Tripler Army Medical Center, Honolulu, HI 96859, USA.
Department of Pathology, Tripler Army Medical Center, Honolulu, HI 96859, USA.
Mil Med. 2023 Nov 3;188(11-12):3687-3691. doi: 10.1093/milmed/usac238.
Primary mediastinal large B-cell lymphoma (PMBCL) is a rare, non-Hodgkin, B-cell lymphoma thought to originate from thymic B cells, which occurs primarily in young adults such as in the active duty population. Primary mediastinal large B-cell lymphoma (PMBCL) presents as a large mediastinal mass, posing risks to the cardiopulmonary safety of patients and challenging the routine approach to diagnosis. We describe a case of a 23-year-old male sailor who presented to sick call on his ship while in port with shortness of breath, night sweats, 50-pound weight loss, and pruritic punched-out lesions on all extremities. An initial chest X-ray showed a large consolidation. After being seen in the pulmonary medicine clinic 5 weeks after his initial presentation, the patient was admitted to the intensive care unit after computed tomography of his chest revealed a mediastinal mass, causing compression of both the right bronchus and superior vena cava with a large pericardial effusion. Empiric high-dose dexamethasone was initiated before a formal diagnosis due to his significant risk for cardiopulmonary compromise. Following diagnosis and two cycles of chemotherapy, the patient was transferred to a medical oncology facility in the continental USA. This case demonstrates the need to educate all military providers to recognize the presentation of mediastinal masses in active duty service members and the importance of urgently escalating these patients to higher levels of care in order to avoid life-threatening complications.
原发性纵隔大 B 细胞淋巴瘤（PMBCL）是一种罕见的非霍奇金 B 细胞淋巴瘤，被认为起源于胸腺 B 细胞，主要发生在年轻人中，如现役人群。原发性纵隔大 B 细胞淋巴瘤（PMBCL）表现为纵隔大肿块，对患者心肺安全构成威胁，并对常规诊断方法提出挑战。我们描述了一例 23 岁男性水手的病例，他在港口的船上因呼吸急促、盗汗、体重减轻 50 磅以及四肢出现瘙痒性穿孔性病变而就诊。初始胸部 X 光片显示大片实变。在最初出现 5 周后在呼吸内科诊所就诊后，患者因胸部计算机断层扫描显示纵隔肿块而被收入重症监护病房，肿块压迫右支气管和上腔静脉，并伴有大量心包积液。由于患者存在心肺功能受损的高风险，在正式诊断之前先使用了经验性大剂量地塞米松。在确诊并接受两个周期的化疗后，患者被转至美国大陆的一家肿瘤内科医疗机构。该病例表明，需要教育所有军队医务人员识别现役军人纵隔肿块的表现，并紧急将这些患者转诊至更高层次的护理，以避免危及生命的并发症。
