History
Young man with three days of chest tightness, dyspnea, fever, and nausea
Chest radiographs are shown below.
1.Which choice does NOT belong in the differential diagnosis?
以下哪项不属于鉴别诊断范围？
Germ cell tumor 生殖细胞瘤
Lymphoma 淋巴瘤
Sarcoma 肉瘤
Thymic tumor 胸腺肿瘤
All of the above belong in the differential diagnosis
以上均需要鉴别诊断
CT images
CT images are shown below.
2.Superior vena cava (SVC) is occluded.
上腔静脉闭塞。
True
False
3.Mass is mostly necrotic.
肿瘤大部分为坏死灶。
True
False
4.There is evidence of pericardial involvement.
心包有受侵。
True
False
5.Which of the following is the MOST LIKELY diagnosis?
最有可能的诊断是什么？
Germ cell tumor 生殖细胞瘤
Lymphoma 淋巴瘤
Sarcoma 肉瘤
Thymic tumor 胸腺肿瘤
None of the above
答案：
- All of the above belong in the differential diagnosis
- False
- False
- TrueCoronal image demonstrates a moderate pericardial effusion.
- LymphomaStatistically speaking, with a huge solid anterior mediastinal mass in a young person, lymphoma of some variety is most likely. That is what this turned out to be.
Findings
- Large soft-tissue anterior mediastinal mass with significant neovascularity前纵隔巨大软组织肿块，内有明显新生血管。
- Substantial posterior mass effect on mediastinal structures with some vascular attenuation纵隔结构明显受压，部分血管受压变形。
- Pericardial and left pleural effusion心包及左侧胸膜受侵。
Differential Diagnosis
- Lymphoma 淋巴瘤
- Germ cell tumor/teraroma 生殖细胞瘤/畸胎瘤
- Thymoma/thymic carcinoma 胸腺瘤/胸腺肉瘤
- Thyroid tumor 甲状腺肿瘤
- Sarcoma 肉瘤
Diagnosis
Large B-cell lymphoma of mediastinum
纵隔大B细胞淋巴瘤
Key Points
- Diffuse large B-cell lymphoma (DLBCL) is a fast-growing, aggressive form of non-Hodgkin\’s lymphoma (NHL).弥漫性大B细胞淋巴瘤（DLBCL）是一种生长迅速、侵袭性强的非霍奇金淋巴瘤（NHL）。
- There are more than 20 types of NHL. DLBCL is the most common type, making up about 30% of all lymphomas.NHL有20多种分型，DLBCL是其中最常见的类型，约占全部淋巴瘤的30%。
- Diffuse large B-cell lymphoma can be fatal if left untreated, but with timely and appropriate treatment, up to half of all patients are curable.弥漫性大B细胞淋巴瘤如果不治疗，可能会危及生命。但如果得到及时、适当的治疗，超过一半的患者可治愈。
- This subtype of DLBCL within the chest cavity usually involves the thymus.胸腔内的DLBCL亚型通常可累计胸腺。
- Primary mediastinal large B-cell lymphoma comprises 7% of all diffuse large B-cell lymphomas and accounts for 2.4% of all non-Hodgkin\’s lymphomas. If this subtype of diffuse large B-cell lymphoma recurs, it can cause problems with other organs, including the liver, gastrointestinal tract, kidneys, ovaries, and central nervous system.原发性纵隔大B细胞淋巴瘤约占全部弥漫性大B细胞淋巴瘤的7%，占全部非霍奇金淋巴瘤的2.4%。如果这种亚型的DLBCL复发，可能会累及其他器官，包括肝脏、胃肠道、肾脏、卵巢、中枢神经系统。
- The five-year survival rate of patients with DLBCL is between 26% and 73%.DLBCL的五年生存率26%-73%。