Presentation
Cough for 1 month.
Patient Data
A large (roughly 9 x 9 x 14 cm) anterior mediastinal soft density mass is noted without internal calcification. The lungs, heart and superior mediastinum appear unremarkable. No osseous lesion identified.
Conclusion:
Large anterior mediastinal mass may represent lymphoma (most likely) or a thymic tumor, metastatic nodal mass, vascular anomaly etc...
This needs prompt further assessment with contrast enhanced CT scan.
A large anterior mediastinal mass measures 13.1 cm transversely and 7.5 cm anteroposteriorly and 10.2 cm craniocaudally. The mass continues superiorly on the right anterolateral to the brachiocephalic artery. The mass contains multiple blood vessels within it.There is a moderate pericardial effusion. A small left pleural effusion is also apparent.
No axillary lymphadenopathy. The lungs are clear. Limited scans to the upper abdomen demonstrate a normal size spleen and no further abnormality.
Conclusion:
Large anterior mediastinal mass. This is most likely lymphoma. Moderate pericardial effusion.
Case Discussion
MICROSCOPIC DESCRIPTION:
The lymph node core biopsies show a proliferation of atypical lymphoid cells, forming diffuse sheets. No follicular structures are seen. The atypical lymphocytes are large in size. They have enlarged clefted and hyperchromatic nuclei, prominent nucleoli and scanty cytoplasm. The large atypical lymphoid cells are CD20, bcl-6 and MUM1 positive. The Ki-67 index is about 50%. They are CD3, CD5, CD10, CD23, Cyclin D1 and bcl-2 negative. The features are those of diffuse large B-cell lymphoma, not otherwise specified, with activated B-cell-like phenotype.
DIAGNOSIS:
Supraclavicular bx: Diffuse large B-cell lymphoma.
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