PMC5577084_01
(A) Computed tomography image of the chest on admission. A tumor measuring approximately 6x3x3 cm was located in the superior vena cava (SVC) and had completely occluded the SVC (arrow). (B) Transesophageal echocardiogram on admission. The tumor occupied the superior vena cava near the right atrium (arrow). (C) 2-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (FDG-PET/CT) image on admission. Abnormal FDG accumulation was observed in the SVC (arrow).
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Enhanced computed tomography of the chest showed a soft tissue shadow in the SVC with numerous collateral vessels in the upper limbs (Fig. 1A). Transesophageal echocardiography showed a high-echoic tumor in the SVC (Fig. 1B) with complete occlusion of the SVC. Although it is rare for a tumor to originate from the large vessels, we conducted positron emission tomography, which showed abnormally high accumulation (SUVmax 24.3) around the SVC (Fig. 1C).
(A and B) Hematoxylin and Eosin staining of the specimen obtained using a transjugular biopsy. Many large atypical lymphoid cells were observed (A: x100, B: x400). (C) CD20 immuno staining of the specimen obtained using a biopsy. CD20 was diffusely positive (x400). (D) CD30 immunostaining. CD30 was diffusely positive on the surface of the tumor cells (x400).
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A histological analysis revealed proliferation of large atypical lymphoid cells (Fig. 2A and B) with phenotypes of CD20 (+), CD30 (+) (Fig. 2C and D), CD3 (-), CD5 (-), CD10 (-), bcl2 (+), and MUM1 (+), which supported a pathological diagnosis of CD30-positive DLBCL.
The clinical course. The patient received rituximab twice weekly followed by five courses of R-CHOP combination therapy alongside anticoagulant therapy. The malignant lymphoma localized in the SVC immediately diminished in size. The abnormal FDG accumulation detected using FDG-PET/CT around the right mediastinum completely disappeared after systemic chemotherapy.
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As a result, the patient achieved complete remission (Fig. 3).