Mediastinal large B-cell lymphoma and pregnancy: challenges in diagnosis and choice of rational medical management

A multigravida woman at term gestation was admitted to the obstetric hospital with complaints of dyspnea at rest and dry cough persisting for the past three months. On examination, signs of severe respiratory failure were evident. Chest computed tomography revealed a large mediastinal mass measuring 200 × 150 mm, compressing mediastinal structures and causing infiltrative changes in the lower lobe of the left lung. Taking into account the life-threatening condition of the pregnant woman and the high risk of a fatal outcome, an emergency delivery was performed simultaneously with a biopsy of the mass. Histological examination of the biopsy material confirmed the diagnosis of diffuse large B-cell lymphoma. In the postoperative period, immunochemotherapy according to the R-CHOP protocol was initiated, resulting in significant reduction in the size of the mass, perifocal edema, and compression of adjacent organs. Ultrasound and magnetic resonance imaging are considered the safest diagnostic modalities during pregnancy. However, it should be remembered that when maternal life is at risk, there are no absolute contraindications to any diagnostic procedures, including radiological imaging, at any gestational age. Modern scanning protocols and protective measures make it possible to minimize perinatal risks.