Relapsed Primary Mediastinal Large B-Cell Lymphoma: The Crucial Role of PET-CT in Evaluating Disease Status and Treatment Response

Authors

  • Wienta Diarsvitri Department of Community Medicine, Faculty of Medicine, Hang Tuah University
  • Carlo Micelli Faculty of Medicine, Hang Tuah University
  • Agnes Stephanie Harahap Anatomical Pathology Department, Faculty of Medicine, Universitas Indonesia/Dr. Cipto Mangunkusumo National Central General Hospital, Indonesia /Human Cancer Research Center-Indonesian Medical Education and Research Institute, Faculty of Medicine, Universitas Indonesia, Indonesia
  • Maria Francisca Ham Anatomical Pathology Department, Faculty of Medicine, Universitas Indonesia/Dr. Cipto Mangunkusumo National Central General Hospital, Indonesia /Human Cancer Research Center-Indonesian Medical Education and Research Institute, Faculty of Medicine, Universitas Indonesia, Indonesia

DOI:

https://doi.org/10.3941/jrcr.5850

Abstract

Despite advances in treating primary mediastinal large B-cell lymphoma, 20–30% of patients experience relapse or refractory disease. We report a case of a patient initially presenting with a neck lump, later diagnosed as primary mediastinal large B-cell lymphoma via biopsy. Initial positron emission tomography/computed tomography imaging showed a large fluorodeoxyglucose-avid anterior mediastinal mass. Following first-line chemotherapy, the disease was found to be refractory, requiring second-line treatment. The positron emission tomography/computed tomography played a key role in evaluating disease extent, treatment response, and relapse, indicated by new hypermetabolic nodes or extranodal lesions. It remains essential in guiding further therapy, including stem cell transplantation and brentuximab vedotin maintenance.

Author Biography

Carlo Micelli, Faculty of Medicine, Hang Tuah University

Faculty of Medicine, Hang Tuah University

Macroscopic images: (A) Left subclavian lymph nodes of the first incisional biopsy, with a soft consistency and white color, measuring 4x3x0.6 cm. (B) The second excisional biopsy of newly diagnosed swollen lymph node measuring 30x15x5 mm. Histopathological features of primary mediastinal B-cell lymphoma (H&E stain): (C) The tumor exhibits a diffuse and vaguely nodular growth pattern with areas of fibrosis. (D) Tumor cells are arranged in sheets, appearing pale due to the presence of clear cytoplasm. (E) The cells are large with pleomorphic nuclei, coarse chromatin, and a combination of clear and eosinophilic cytoplasm. (F) Foci of tumor necrosis are also observed. Immunohistochemical profile of primary mediastinal large B-cell lymphoma: (G) Tumor cells show diffuse positivity for CD20. (H) CD3 staining is negative. (I) The Ki-67 proliferation index is high, indicating a high proliferative activity. (J, K) CD30 and CD23 expression demonstrate heterogeneous positivity. (L) CD10 staining is negative.

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Published

2025-10-31

Issue

Vol. 19 No. 10 (2025)

Section

General Radiology

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