Medicina de Emergência: Acesso Aberto
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Rare Presentation of Diffuse Large B-Cell Lymphoma in a Young Woman with a Newly Found Mediastinal Mass

Chiung-Chang Liu*, Wei-Cheng Wen, Kuang-Yu Niu

Mediastinal widening on chest radiography is a concerning sign in patients visiting the emergency room. Among young patients, the most common cause of mediastinal widening is that of a tumorous origin. Here we present the case of a 29-year-old woman who presented to the emergency room with a chief complaint of dry cough for 2 months. Chest radiography revealed mediastinal widening and bilateral pleural effusion. Contrast-enhanced computed tomography of the chest revealed a huge heterogeneous anterior mediastinal mass with hilar and subcarinal extension. The patient was admitted to the internal medicine ward and she underwent ultrasound-guided pleurocentesis. Pleural fluid analysis revealed an exudative characteristic; however, pleural fluid bacterial culture and tuberculosis culture were negative. The patient underwent excisional biopsy of the right neck lymph node, and the pathology report revealed diffused large size malignant lymphoid cell infiltration. Immunohistochemical staining revealed CD10^-, CD20⁺⁺⁺, Bcl-2⁺⁺⁺, and ki67⁺ (>90%), thereby confirming the diagnosis of diffuse large B-cell lymphoma.

Emergency physicians are always aware of great vessel diseases in cases of newly found mediastinal widening. However, mediastinal masses should also be considered in the differential diagnosis. Diffuse large B-cell lymphoma is rarely observed in an emergency setting, especially in cases where patients present to the emergency room with an uncommon presentation of lymphoma. Early detection relies on a high level of clinical suspicion and accurate diagnosis is still based on the pathological morphology and immunophenotyping. However, a general work-up should be performed in the case of newly found mediastinal widening.