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Koo ZP, Chainchel Singh MK, Mohamad Noor MHB, Omar NB, Siew SF. Fatal anterior mediastinal mass in a pregnant lady. Forensic Sci Med Pathol 2024; 20:226-232. [PMID: 37436679 DOI: 10.1007/s12024-023-00669-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2023] [Indexed: 07/13/2023]
Abstract
We report a fatal case of a 26-year-old nulliparous woman who presented with an anterior mediastinal mass in her late pregnancy. She had complained of a progressively increasing neck swelling and occasional dry cough in the early second trimester, which was associated with worsening dyspnoea, reduced effort tolerance and orthopnoea. Ultrasound of the neck showed an enlarged lymph node, and chest X-ray revealed mediastinal widening. At 35 weeks' gestation, the patient was referred to a tertiary centre for a computed tomography (CT) scan of the neck and thorax under elective intubation via awake fibreoptic nasal intubation as she was unable to lie flat. However, she developed sudden bradycardia, hypotension and desaturation soon after being positioned supine, which required resuscitation. She succumbed after 3 days in the intensive care unit. An autopsy revealed a large anterior mediastinal mass extending to the right supraclavicular region, displacing the heart and lungs, encircling the superior vena cava and right internal jugular vein with tumour thrombus extending into the right atrium. Histopathology examination of the mediastinal mass confirmed the diagnosis of a primary mediastinal large B-cell lymphoma. This report emphasizes the severe and fatal outcome resulting from the delay and misinterpretation of symptoms related to a mediastinal mass.
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Affiliation(s)
- Zhao Peng Koo
- Department of Forensic Pathology, University of Malaya Medical Centre, Jln Profesor Diraja Ungku Aziz, 59100, Kuala Lumpur, Malaysia.
| | - Mansharan Kaur Chainchel Singh
- National Institute of Forensic Medicine, Kuala Lumpur Hospital, Ministry of Health, Kuala Lumpur, Malaysia
- Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi Mara (UiTM), Sg Buloh, Selangor, Malaysia
- Faculty of Medicine, Universiti Teknologi Mara (UiTM), Sg Buloh, Selangor, Malaysia
| | | | - Norhayati Binti Omar
- Department of Pathology, Kuala Lumpur Hospital, Ministry of Health, Kuala Lumpur, Malaysia
| | - Sheue Feng Siew
- National Institute of Forensic Medicine, Kuala Lumpur Hospital, Ministry of Health, Kuala Lumpur, Malaysia
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Ahuja J, Strange CD, Agrawal R, Erasmus LT, Truong MT. Approach to Imaging of Mediastinal Masses. Diagnostics (Basel) 2023; 13:3171. [PMID: 37891992 PMCID: PMC10606219 DOI: 10.3390/diagnostics13203171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/04/2023] [Accepted: 10/07/2023] [Indexed: 10/29/2023] Open
Abstract
Mediastinal masses present a diagnostic challenge due to their diverse etiologies. Accurate localization and internal characteristics of the mass are the two most important factors to narrow the differential diagnosis or provide a specific diagnosis. The International Thymic Malignancy Interest Group (ITMIG) classification is the standard classification system used to localize mediastinal masses. Computed tomography (CT) and magnetic resonance imaging (MRI) are the two most commonly used imaging modalities for characterization of the mediastinal masses.
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Affiliation(s)
- Jitesh Ahuja
- Department of Thoracic Imaging, The University of Texas MD Andeson Cancer Center, Houston, TX 77030, USA; (C.D.S.); (R.A.); (M.T.T.)
| | - Chad D. Strange
- Department of Thoracic Imaging, The University of Texas MD Andeson Cancer Center, Houston, TX 77030, USA; (C.D.S.); (R.A.); (M.T.T.)
| | - Rishi Agrawal
- Department of Thoracic Imaging, The University of Texas MD Andeson Cancer Center, Houston, TX 77030, USA; (C.D.S.); (R.A.); (M.T.T.)
| | - Lauren T. Erasmus
- Department of Anatomy and Cell Biology, Faculty of Sciences, McGill University, Montreal, QC H3A 0G4, Canada;
| | - Mylene T. Truong
- Department of Thoracic Imaging, The University of Texas MD Andeson Cancer Center, Houston, TX 77030, USA; (C.D.S.); (R.A.); (M.T.T.)
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Ghigna MR, Thomas de Montpreville V. Mediastinal tumours and pseudo-tumours: a comprehensive review with emphasis on multidisciplinary approach. Eur Respir Rev 2021; 30:30/162/200309. [PMID: 34615701 PMCID: PMC9488622 DOI: 10.1183/16000617.0309-2020] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 01/08/2021] [Indexed: 12/02/2022] Open
Abstract
The diagnosis of a mediastinal mass may be challenging for clinicians, since lesions arising within the mediastinum include a variety of disease entities, frequently requiring a multidisciplinary approach. Age and sex represent important information, which need to be integrated with imaging and laboratory findings. In addition, the location of the mediastinal lesion is fundamental; indeed, we propose to illustrate mediastinal diseases based on the compartment of origin. We consider that this structured approach may serve as hint to the diagnostic modalities and management of mediastinal diseases. In this review, we present primary mediastinal tumours in the evolving context of new diagnostic and therapeutic tools, with recently described entities, based on our own experience with >900 cases encountered in the past 10 years. Given the mediastinal anatomical heterogeneity, the correct positioning of mediastinal lesions becomes primal, in order to first establish a clinical suspicion and then to assist in planning biopsy and surgical procedurehttps://bit.ly/3p0gsk3
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Affiliation(s)
- Maria-Rosa Ghigna
- Dept of Pathology, Marie Lannelongue Hospital, Le Plessis Robinson, France
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Yu Y, Dong X, Tu M, Wang H. Primary mediastinal large B cell lymphoma. Thorac Cancer 2021; 12:2831-2837. [PMID: 34590432 PMCID: PMC8563158 DOI: 10.1111/1759-7714.14155] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/29/2021] [Accepted: 08/30/2021] [Indexed: 02/01/2023] Open
Abstract
Primary mediastinal large B cell lymphoma (PMBCL) is an aggressive large B cell lymphoma originating in the mediastinum, that mainly expresses B cell surface molecules, such as CD19, CD20, CD22, andCD79a. Clinically, they are characterized by rapidly increasing anterior mediastinal masses, which can cause compression of the surrounding tissues. The diagnosis of PMBCL mainly depends on the pathological features, imaging examination and clinical features. Currently, the most commonly used therapeutic regimens are R‐CHOP and R‐EPOCH. Radiotherapy is beneficial in some patients, but it can also lead to long‐term toxicity. The research and development of novel therapies are ongoing, and some studies have achieved encouraging results, including those conducted on chimeric antigen receptor‐modified T (CAR‐T) cell therapy and anti‐PD‐1 drugs. However, randomized controlled trials with larger sample sizes are still needed. Positron emission tomography‐computed tomography (PET‐CT) is mainly used to assess the curative effect after treatment and to guide the subsequent treatment strategy.
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Affiliation(s)
- Yating Yu
- Department of Hematology, General Hospital, Tianjin Medical University, Tianjin, China
| | - Xifeng Dong
- Department of Hematology, General Hospital, Tianjin Medical University, Tianjin, China
| | - Meifeng Tu
- Department of Lymphoma, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
| | - Huaquan Wang
- Department of Hematology, General Hospital, Tianjin Medical University, Tianjin, China
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Venkitakrishnan R, Paul M, Sleeba T, Abraham L, Joshi M, Augustine J, Ramachandran D, Cleetus M, Vijay A. Expecting the unexpected - Primary mediastinal large B cell lymphoma presenting as huge lung parenchymal mass. Respir Med Case Rep 2021; 32:101370. [PMID: 33717867 PMCID: PMC7921618 DOI: 10.1016/j.rmcr.2021.101370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/02/2021] [Accepted: 02/13/2021] [Indexed: 11/17/2022] Open
Abstract
The first possibility considered in the etiology of large lung masses is neoplastic lesions. The differential diagnoses of these masses include bronchogenic carcinoma, pulmonary sarcoma, primitive neuroectodermal tumor etc. Primary or secondary pulmonary parenchymal lymphomas presenting as large mass is distinctly rare. We share the case of a young lady who presented with a large left lung mass almost entirely replacing the left lung parenchyma, with associated intrathoracic lymphadenopathy. On evaluation she was proved to have primary mediastinal large B-cell lymphoma. Treatment with an aggressive chemotherapy regimen led to complete remission of the parenchymal and nodal disease. The uncommon radiological presentation and the excellent therapeutic response despite huge tumor load merit clinical attention.
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Affiliation(s)
| | - Mobin Paul
- Pulmonary Medicine, Rajagiri hospital, Aluva, Kochi, Kerala
| | - Teena Sleeba
- Pulmonary Medicine, Rajagiri hospital, Aluva, Kochi, Kerala
| | - Latha Abraham
- Pulmonary Medicine, Rajagiri hospital, Aluva, Kochi, Kerala
| | - Manisha Joshi
- Pulmonary Medicine, Rajagiri hospital, Aluva, Kochi, Kerala
| | | | | | - Melcy Cleetus
- Pulmonary Medicine, Rajagiri hospital, Aluva, Kochi, Kerala
| | - Anand Vijay
- Pulmonary Medicine, Rajagiri hospital, Aluva, Kochi, Kerala
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Abstract
PURPOSE OF REVIEW Imaging features of lymphoma vary regionally. Awareness of site-specific key imaging characteristics of lymphoma can aid in rapid staging and assist in prompt treatment. FDG PET/CT and conventional MRI are readily available diagnostic modalities with excellent sensitivity and good specificity. Diagnostic specificity can be enhanced using emerging PET radiotracers, e.g., FLT and FET. RECENT FINDINGS Emerging research has shown higher dimensional analysis (radiomics and radiogenomics) of imaging data can yield information of the underlying genetic aberrations in lymphoma, which can aid in assessing real-time evolution of tumor. CT, PET/CT, MRI, and ultrasound accentuate the intrinsic qualities of lymphoma (e.g., FDG PET/CT for increased metabolic activity, FLT PET/CT for increased proliferation index, and DWI for increased cellularity) and play an essential role in its diagnosis and examination. Advanced radiogenomic analyses use radiomic parameters to deduce genetic variations of lymphoma, providing noninvasive, repeatable, and real-time surveillance of its genetic progression.
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