Articles Tập 67 Số CĐ13-HNKH Bệnh viện 19-8 10/09/2026

PRIMARY MEDIASTINAL LARGE B-CELL LYMPHOMA: A CHALLENGING DIAGNOSTIC CASE AND ITS THERAPEUTIC IMPLICATIONS

Toản Dương Đình, Giang Lê Hảo, Hưng Nguyễn Văn, Ly Phùng Thị, Lăng Ngô Văn, Lệ Nguyễn Thị Nhật
DOI: 10.52163/yhc.v67iCD13.6413
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Keywords
Primary mediastinal large B-cell lymphoma; PMBCL; mediastinum; sarcoma-like morphology; immunohistochemistry.
Abstract

Primary mediastinal large B-cell lymphoma (PMBCL) is a rare subtype of aggressive large B-cell lymphoma that typically presents as an anterior mediastinal mass in young adults. We report the case of a 35-year-old man who presented with chest discomfort, and imaging studies revealed a large anterior mediastinal mass. Histopathological examination of a core needle biopsy demonstrated a pleomorphic neoplasm composed of large tumor cells arranged in solid nests within a dense collagenous fibrous stroma, initially suggesting a high-grade sarcoma. Initial immunohistochemical analysis showed diffuse positivity for vimentin and CD31, raising suspicion for angiosarcoma. However, an expanded immunohistochemical panel demonstrated strong expression of CD45 (LCA), CD19, CD20, CD23, and CD30, while the tumor cells were negative for cytokeratin (CK), epithelial membrane antigen (EMA), and CD15, thereby establishing the diagnosis of PMBCL. The patient was treated with R-CHOP chemotherapy followed by consolidative mediastinal radiotherapy. After 11 months of follow-up, the patient achieved a complete metabolic response according to the Lugano 2014 criteria based on PET/CT evaluation. This case highlights that PMBCL may exhibit a sarcoma-like morphological appearance, creating significant diagnostic challenges in limited biopsy specimens, and underscores the importance of a systematic immunohistochemical approach in the differential diagnosis of mediastinal tumors

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