Primary Mediastinal B-Cell Lymphoma: The Role of Consolidative Radiation for a “Terrible” Lymphoma

Abstract

A 26-year-old male presented with shortness of breath, cough, and chest pain with a 2-year history of diffuse skin lesions. He underwent evaluation with computed tomography (CT) and follow-up positron emission tomography (PET)/CT imaging, identifying a 17.3 Â 8.0 cm anterior mediastinal mass (Fig. 1A). Biopsy identified a diffuse large B-cell lymphoma, positive for CD45, CD20, and CD23 with a Ki-67 of 35%. There was partial positivity of BC-6 and CD30. The biopsy was negative for CD10, CD15, C-MYC, CD5, CD13, and EBER. Because of its location, it was classified as a primary mediastinal B-cell lymphoma.The patient initiated therapy with dose-adjusted rituximab, etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin (R-EPOCH). He had resolution of his symptoms, including the skin lesions, after completion of 2 cycles of R-EPOCH. An interval PET/CT obtained at this time showed 8 cm of residual disease with a Deauville 3 response (Fig. 1B). The patient had a follow-up PET/CT 2 months after completion of 6 cycles of R-EPOCH therapy that showed 4.2 cm of residual disease and persistent Deauville 3 response (Fig. 1C).