Mediastinal large B-cell lymphoma and pregnancy: difficulties in diagnosis and choice of rational medical tactics

A woman pregnant for the second time was admitted to the obstetric hospital at full-term gestational age with complaints of dyspnea at rest and dry cough, which had been bothering her for the past three months. During examination, signs of severe respiratory failure were noticeable. Based on the results of computed tomography of the chest organs, a volumetric formation measuring 200x150 mm with compression of the mediastinal organs and infiltrative changes in the lower lobe of the left lung was revealed. Given the life-threatening condition of the pregnant woman with a high risk of death, a decision was made to perform an emergency delivery with simultaneous biopsy of the space-occupying lesion. Based on the results of histological examination of the biopsy material, diffuse large B-cell lymphoma was detected. In the postoperative period, immunochemotherapy was started according to the RCHOP regimen, which resulted in a significant decrease in the size of the lesion, perifocal edema, and the degree of compression of adjacent organs. The safest diagnostic methods during pregnancy are ultrasound and magnetic resonance imaging (MRI). However, it should be remembered that if there is a threat to the mother's life, there are no absolute contraindications to various research methods, including radiation, at any stage of gestation. Modern scanning protocols, as well as protective equipment, help minimize perinatal risks.