Primary mediastinal large B cell lymphoma in pregnancy: a case report and review of the literature

BACKGROUND: Primary mediastinal B-cell lymphoma (PMBCL) is a subtype of diffuse large B-cell lymphoma (DLBCL) that typically presents as a large mass originating in the mediastinum and infiltrating the surrounding organs, resulting in pleural and pericardial effusions. The occurrence of PMBCL during pregnancy presents a significant challenge to clinical management, necessitating a comprehensive consideration of the unique risks posed to both the pregnant woman and the foetus when selecting the optimal treatment. This report presents cases of PMBCL diagnosed during late pregnancy and reviews the pertinent literature, emphasising the necessity of prompt diagnosis and the implementation of tailored management strategies for different stages of pregnancy to enhance pregnancy outcomes. CASE PRESENTATION: A 29-year-old woman with four documented pregnancies, yet no documented deliveries. At 15 weeks' gestation, the patient presented at the local hospital with a cough, which was diagnosed as an upper respiratory tract infection. She was treated with oral antibiotics; however, there was no significant improvement in her condition. During the 28th week of gestation, the patient's respiratory distress and dysphagia worsened, and she was unable to assume a recumbent position. The patient was admitted to our hospital with a computed tomography scan indicating the presence of a sizable mediastinal mass. Given the potential risks, benefits, and recent status, a decision was made to perform an emergency caesarean section. The procedure resulted in the successful delivery of the foetus, with Apgar scores of 6, 7, and 7 at 1, 5, and 10 minutes, respectively. A comprehensive examination of the neonate revealed no additional abnormalities and demonstrated normal developmental progress after a period of over four months. Following delivery, the diagnosis of PMBCL was confirmed by puncture biopsy of the mediastinal mass and PET-CT. The pregnant woman then received five doses of DA-EPOCH-R chemotherapy, resulting in a significant reduction of the mediastinal mass and remission of her symptoms. CONCLUSION: This case study illustrates the significant challenges associated with diagnosing and treating Primary mediastinal B-cell lymphoma during pregnancy. In this rare and complex case, the timing of termination of pregnancy and the choice of treatment regimen are of critical importance in order to improve maternal and infant outcomes.