Diagnosis: Diffuse large B-cell lymphoma
This patient had Stage IV-B diffuse large B-cell lymphoma (DLBCL), diagnosed by computed tomography (CT)-guided biopsy of the mediastinal mass. DLBCL is the most common histological subtype of non-Hodgkin lymphoma (NHL), accounting for approximately 30% of NHL cases.1,2
Patients with DLBCL typically present with a rapidly enlarging mass in the neck or abdomen. Thirty percent of patients will have systemic “B” symptoms, including fever, weight loss, and night sweats.3 DLBCL can be highly invasive and may cause compression of the airway and lymphatic or circulatory vessels. While dysphagia, hoarseness, breast swelling, chest pain, and cough can be among the presenting symptoms, superior vena cava syndrome is the most common complication and occurs in 30% of patients.3 The lymphatic obstruction seen in lymphoproliferative disease can produce lymphedema.
In this patient, diffuse lymphadenopathy in the subpectoral and axillary region caused lymphatic obstruction and breast edema. Extra-nodal disease occurs in up to one-third of cases.4 DLBCL can be involved in virtually any tissue, including breast, bone, testes, skin, liver, central nervous system, uterus, and gastrointestinal tract.5
The National Cancer Institute reports that between 2004 and 2008, the US age-adjusted incidence rate for non-Hodgkin lymphoma was 19.8 per 100,000 men and women per year.6 Incidence varies by ethnicity (Caucasians have the highest rate) and increases with age (median age at diagnosis is 66 years with a male predominance).6