Alizadehasl Azin, Roudini Kamran, Hesami Mahshid, Kosari Farid, Pouraliakbar Hamid Reza, Mohseni Mina, Dokhani Negar
Cardio-Oncology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
Department of Internal Medicine, Hematology and Medical Oncology Ward, Cancer Research Center, Cancer Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
Cardiooncology. 2023 May 31;9(1):27. doi: 10.1186/s40959-023-00173-2.
Mediastinal gray zone lymphoma is a newly recognized rare B cell neoplasm, which is challenging in diagnosis and treatment.
In the current study, we aimed to report a 25-year-old pregnant woman at 25 weeks of gestation who presented with chronic cough and progressive shortness of breath, hypotension, tachycardia, and tachypnea. A large circumferential pericardial effusion with compressive effect on the right atrium and right ventricle and a large extracardiac mass with external pressure to mediastinal structures were seen on trans thoracic echocardiography. The emergency pericardiocentesis was performed with the diagnosis of cardiac tamponade. Also, CMR revealed a huge heterogeneous anterior mediastinal mass, and the pathology and the immunohistochemistry of the mass biopsy revealed gray zone lymphoma with positive CD3, CD20, CD30, CD45, PAX5, and negative CD15 expression. Three courses of chemotherapy with the CHOP regimen were performed with an acceptable response every three weeks before delivery. A caesarian section was performed at 37 weeks without any problem for the patient and fetus, and chemotherapy will be started three weeks after delivery.
Cardiac tamponade as an emergency condition occurred in this pregnant patient by malignant pericardial effusion and mediastinal mass pressure. Accurate diagnosis and on time interventions caused a significant improvement and a successful delivery.
纵隔灰色地带淋巴瘤是一种新发现的罕见B细胞肿瘤，其诊断和治疗具有挑战性。
在本研究中，我们旨在报告一名25岁、孕25周的孕妇，她出现慢性咳嗽、进行性气短、低血压、心动过速和呼吸急促。经胸超声心动图显示有大的环形心包积液，对右心房和右心室有压迫作用，还有一个大的心外肿块对纵隔结构有外部压迫。诊断为心脏压塞后进行了紧急心包穿刺术。此外，心脏磁共振成像显示前纵隔有一个巨大的异质性肿块，肿块活检的病理和免疫组化显示为灰色地带淋巴瘤，CD3、CD20、CD30、CD45、PAX5呈阳性，CD15表达阴性。在分娩前每三周进行三个疗程的CHOP方案化疗，反应可接受。孕37周时进行了剖宫产，对患者和胎儿均无任何问题，产后三周将开始化疗。
该孕妇因恶性心包积液和纵隔肿块压迫出现心脏压塞这一紧急情况。准确的诊断和及时的干预带来了显著改善并成功分娩。
