Superior vena cava syndrome related to mediastinal lymphoma in late pregnancy: A case report

Abstract

We report the initial diagnosis in a 28-year-old nulliparous woman of a primary mediastinal B-cell lymphoma in late pregnancy. For several weeks the patient had had symptoms of mediastinal obstruction, such as dyspnea, cough, swelling of the face and upper limbs. However, these symptoms had been misattributed to the pregnancy and a common cold. Due to a rapid decline in the patient's cardiovascular performance, she was transferred to the closest perinatal center in the 34th week of pregnancy, whereupon a cesarean section was performed. The diagnosis of a primary mediastinal B-cell lymphoma was made postpartum from a biopsy. This case emphasizes the importance of timely antenatal investigation in pregnant women with symptoms consistent with mediastinal obstruction. Thoracic ultrasonography can be a valuable tool for the detection of tumor-associated pleural and pericardial effusions.

Unusual Presentation of Hodgkin’s Lymphoma in Pregnancy: A Case Report and Systematic Review of Literature

“…All included studies were case reports and original articles. Ten studies diagnosed pregnant women with nodular sclerosis HL [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 ], Five described management of pregnant women diagnosed with lymphocyte-rich HL [ 14 , 15 , 16 , 17 , 18 ], and one study described management of pregnant patient with stage-4 classical HL [ 19 ]. Ten of the included studies treated all pregnant patients diagnosed with HL with standard cycle of ABVD with no report of maternal or fetal complications from the chemotherapy regimen [ 5 , 6 , 7 , 8 , 9 , 10 , 12 , 17 , 19 ], but with the exception of three studies; in which one of the three studies reported that ABVD chemo therapy resulted in preterm contraction and rupture of membrane [ 5 ], second study described the addition of 25 mg/m 2 doxorubicin per cycle of ABVD which resulted in left cardiac dysfunction with high levels of troponin in the newborn on day 4 of life which later resolved on month one of life [ 16 ], and the third study reported an adverse effect with ABVD chemotherapy resulting in preterm birth, and the need for immediate post-partum blood transfusion with subsequent development of venous thromboembolism in the mother [ 11 ].…”

“…For the treatment of HL with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisolone), five studies [ 4 , 9 , 12 , 14 , 15 ] reported no complication with the chemo regimen in pregnant patients and their fetuses. It was observed that R-CHOP was commonly used for the chemotherapeutic regimen in pregnant patients diagnosed with lymphocyte-rich HL while ABVD regimen was more popular for the treatment of nodular sclerosing HL.…”

“…A mediastinal mass occurs in most patients with nodular Sclerosing CHL. Clinical symptoms like fever, extreme fatigue, and night sweats can occur in about 25% of the cases [ 4 ]. In pregnancy, missed diagnosis is possible as lymphoma mimics the symptoms that typically accompany pregnancy, for example: dyspnea, fatigue, or night sweats.…”

Complicaciones cardiovasculares en gestante con linfoma primario mediastinal de células B

“…El linfoma primario mediastinal de células B grandes (LPMCB) es un tipo raro de linfoma (3% de todos los linfomas no Hodgkin y 6 a 10% de los linfomas de células B difusos); es más frecuente en mujeres (relación 3:1), en la tercera y cuarta década de la vida (4) . Puede presentarse en cualquier trimestre de la gestación y esta condición pareciera no afectar el curso natural del linfoma, pero dificulta la estadificación y decisiones del manejo (5) , como se presentaron en el caso reportado. Este tipo de linfoma es de rápido crecimiento y su cuadro clínico es de pocos meses, sus principales síntomas y signos son relacionados a la compresión de órganos adyacentes: disnea, disfagia, tos, voz ronca, compresión de vasos y síndrome de vena cava superior; los síntomas generales como fiebre o pérdida de Figura 2.…”

“…El linfoma primario mediastinal de células B grandes (LPMCB) es un tipo raro de linfoma (3% de todos los linfomas no Hodgkin y 6 a 10% de los linfomas de células B difusos); es más frecuente en mujeres (relación 3:1), en la tercera y cuarta década de la vida 4 . Puede presentarse en cualquier trimestre de la gestación y esta condición pareciera no afectar el curso natural del linfoma, pero dificulta la estadificación y decisiones del manejo 5 , como se presentaron en el caso reportado.…”