Progression of double‐hit lymphoma in the midst of R‐hyper CVAD

Abstract

A 50-year-old female with no medical history presented with B-symptoms for 2 weeks including generalized weakness, fevers, fatigue, and night sweats. Physical exam revealed diffuse cervical and axillary lymphadenopathy with splenomegaly. Initial laboratories showed Coombs-negative hemolytic anemia with agglutination of red blood cells and moderate thrombocytopenia. Some tear drop cells were also seen pointing toward the presence of bone marrow infiltration. Computed tomography (CT) of the body showed a mediastinal mass with widespread lymphadenopathy and splenomegaly. Image 1. Panel A: Right axillary lymph node excisional biopsy showing BCL-2 positivity. Panel B: Right axillary lymph node excisional biopsy showing CD10 positivity. Panel C: Right axillary lymph node excisional biopsy showing follicular low-grade lymphoma. Panel D: Right axillary lymph node excisional biopsy showing low MIB1. Panel E: Mediastinal mass biopsy showing DLBCL with blastoid features. Panel F: Mediastinal mass biopsy showing high MIB1. Panel G: Baseline CT showing a mediastinal mass. Panel H: The mediastinal mass rapidly responded to high dose chemotherapy achieving radiographic complete response after three cycles. Panel I: CT showing recurrence of the mediastinal mass encasing the major thoracic organs.