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Weekly Chest CasesArchive of Old Cases

Case No : 1147 Date 2019-10-23

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  • Courtesy of ChoHee Kim, Ho Yun Lee / Samsung Medical Center
  • Age/Sex 56 / M
  • Chief ComplaintAbnormality in health screening
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Primary mediastinal large B-cell lymphoma
Radiologic Findings
Fig 1. Chest PA shows mediastinal widening.
Fig 2-3. CT scans reveal about 55 mm-sized lobulated mass in right upper lobe with invasion to anterior mediastinum. The mass shows heterogeneous enhancement with internal low density. A few borderline-sized lymph nodes are also seen in anterior mediastinum.
Fig 4-5. In follow up CT scans after 2 month, the lobulated mass shows increased size with increased internal necrotic portion. Small amount of pericardial effusion also newly seen.
Brief Review
Lymphomas are responsible for approximately 15% of all primary mediastinal masses. Only 10% of lymphomas which involve the mediastinum are primary and the majority (~60%) are Hodgkin's lymphomas (HL).
Although HL and non-hodgkins lymphoma (NHL) may have overlapping imaging findings, HL is characterized by the presence of a discrete anterior mediastinal mass with a lobulated contour. The tumor most commonly demonstrates homogeneous soft-tissue attenuation, although large lymph node masses may demonstrate heterogeneity with complex low attenuation representing necrosis, hemorrhage, or cystic degeneration.
Lymph nodes involved in NHL tend to be larger as compared with those in HL and have a predilection for noncontiguous or hematogenous spread to thoracic and distant nodal and extranodal sites. Large B-cell lymphoma and lymphoblastic lymphoma are the most common subtypes, primarily involving the anterior mediastinum. Specifically, primary mediastinal large B-cell lymphomas usually present large and lobulated anterior mediastinal masses and occur predominantly in young adults, while also often directly invading adjacent structures. Low attenuation areas of necrosis within the mass were seen in 50% and calcification in 5%.
Please refer to
Case 488, Case 492, Case 619, Case 894, Case 1019,
References
1. Duwe BV, Sterman DH, Musani AI. Tumors of the mediastinum. Chest. 2005;128 (4): 2893-909.
2. Bae YA, Lee KS. Cross-sectional evaluation of thoracic lymphoma. Radiol Clin North Am. 2008 Mar;46(2):253-64
Keywords
anterior mediastinum, Primary Pulmonary Lymphoma , B-cell lymphoma ,

No. of Applicants : 61

▶ Correct Answer : 11/61,  18.0%
  • - Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
  • - National Center for Global Health and Medicine , Japan MASATOSHI HOTTA
  • - Chonnam National University Hwasun Hospital , Korea (South) WONGI JEONG
  • - , Korea (South) CHOHEE KIM
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Chonnam National University Hospital , Korea (South) PARK SEUNG GWI
  • - Chonnam National University Hospital , Korea (South) JONG EUN LEE
  • - Chonnam National University Hospital , Korea (South) BYEONGHAK SIM
  • - Myongji Hospital , Korea (South) KI EON KWON
  • - IRSA LA ROCHELLE , France JEAN LUC BIGOT
  • - ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
▶ Correct Answer as Differential Diagnosis : 29/61,  47.5%
  • - The University of Tokyo Hospital , Japan RYO KUROKAWA
  • - Korea University Anam Hospital , Korea (South) KYU-CHONG LEE
  • - , Korea (South) JANG SEONG WON
  • - , Korea (South) JIN YOUNG LEE
  • - Seoul National University Hospital , Korea (South) JI HEE KANG
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - , Japan NAOMI YUASA
  • - National Center for Global Health and Medicine , Japan HIROSHI TAKUMIDA
  • - Other , Korea (South) INSOO JANG
  • - Other , Korea (South) SEONGSU KANG
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
  • - Kyeongpook National University Hospital , Korea (South) MIRAN KIM
  • - , Taiwan NING CHIEN
  • - Ondokuz Mayis University , Turkey CETIN CELENK
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - University of Tsukuba Hospital , Japan HIROAKI TAKAHASHI
  • - , Korea (South) HYEYOUNG CHOI
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - Dae Jin Medical Center , Korea (South) JIYOUNG CHOI
  • - Asan Medical Center , Korea (South) JIHOON KIM
  • - , Korea (South) GABIN YUN
  • - Diagnose.me (BV) / Royal Perth Hospital , Australia YURANGA WEERAKKODY
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Toranomon Hospital , Japan KAORU SUMIDA
  • - The Jikei university , Japan TAKU GOMI
  • - Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - Hamamatsu University Hospital , Japan YUKI HAYASHI
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