Primary Mediastinal (Thymic) Large B-Cell Lymphoma and Classical Hodgkin Lymphoma: A Rare Case of Synchronous Lymphoid Tumors

Combined lymphoproliferative diseases always present rare and difficult-to-interpret clinical and immunomorphological situations. There are no uniform standards either for diagnosis nor for treatment of such diseases. The present paper reports a rare case of synchronous primary mediastinal (thymic) large B-cell lymphoma in a female patient with a big tumor mass in the anterior superior mediastinum and classical Hodgkin lymphoma with bone and bone marrow involvements. Combined malignancy was diagnosed after the immunomorphological analysis of the voluminous mediastinal lesion, vertebra L3, and bone marrow which had been carried out in two reference pathology laboratories. The patient received 6 chemotherapy ЕРСН-BV-R cycles (etoposide, prednisolone, cyclophosphamide, doxorubicin, and rituximab with prolonged infusion of chemotherapeutic agents replacing vincristine by brentuximab vedotin). The therapy proved to be highly effective with acceptable toxicity profile. Complete remission was confirmed by positron emission tomography and histological analysis of the bone marrow.