Expecting the unexpected – Primary mediastinal large B cell lymphoma presenting as huge lung parenchymal mass

Figures

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  Fig. 1. Chest x ray (PA view): Near total homogenous opacification of the left hemithorax. Mediastinal shift to right side is noted.

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  Fig. 2. (a, b): Post contrast CT thorax images in coronal and axial sections. Heterogeneously enhancing mass lesion replacing the left lung. A small patch of aerated left lower lobe was noted (blue arrow).Enlarged perivascular, subcarinal and left axillary nodes seen (white stars).

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  Fig. 3. (a, b): Post contrast CT thorax images in axial and sagittal sections. Extra thoracic extension into left breast seen (White arrow head). Pericardial (star) and pleural effusion with deposits noted (Back arrowhead).

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  Fig. 4. a, b and c – Histopathology images of the biopsy specimen from left lung. (a - H&E stain high power showing sheets of medium to large sized lymphoid cells with abundant pale cytoplasm, round to ovoid vesicular nuclei with nucleoli. Neoplastic cells separated into compartments by fibrous tissue; b – Immunohistochemistry with CD 20 positivity; c – Immunohistochemistry with CD 23 positivity).

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  Fig. 5. a and b. Chest x ray at presentation compared with that after 3 cycles of chemotherapy show partial clearance of the mass lesion from the left hemithorax with increase in lung aeration.

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  Fig. 6. Limited CT sections taken during the course of treatment showing areas of traction bronchiectasis (black arrow head), cicatricial atelectasis and minimal persisting residual disease.