Diffuse Large B-Cell Lymphoma of the Posterior Cervical Trachea Causing Severe Airway Obstruction: A Case Report

Malignant lymphoma arising from the posterior cervical tracheal region is extremely rare and may cause severe respiratory failure. We report the case of a 64-year-old woman who initially presented with throat discomfort and subsequently developed dyspnea and upper airway stridor. Computed tomography showed a solid tumor measuring 38 mm at the right posterolateral aspect of the trachea, resulting in airway narrowing to 8 mm in diameter. Bronchoscopic examination revealed compressive stenosis of the dorsal tracheal wall in the subglottic area, and six biopsy specimens were obtained. While waiting for the pathological diagnosis, the patient's respiratory condition deteriorated, and the tracheal lumen further narrowed to 6 mm. Corticosteroid therapy was initiated, leading to modest clinical improvement. Immunohistochemical analysis confirmed stage IE diffuse large B-cell lymphoma (DLBCL), and R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone) chemotherapy was subsequently initiated. After the first treatment cycle, the tumor had almost completely regressed. This case highlights the importance of prompt histopathological diagnosis and appropriate airway management. Although DLBCL can progress rapidly, it responds well to corticosteroids and chemotherapy, and timely intervention may lead to favorable clinical outcomes.