Mediastinal large-cell lymphoma

The records of 20 patients with pathologically diagnosed mediastinal large-cell lymphoma with sclerosis, a recently documented but uncommon subtype of mediastinal non-Hodgkin's lymphoma, were retrospectively reviewed to determine the clinical and radiologic features of the condition at the time of presentation. The disease was staged according to the Ann Arbor classification: 15 patients presented in clinical stage I or II and 5 in clinical stage III or IV. The patients, 6 women and 14 men, ranged in age from 15 to 63 years (mean = 31 years). Chest pain (experienced by 10 patients), dyspnea (by 9) and cough (by 7) were the most common clinical features. Obstruction of the superior vena cava occurred in seven patients. The mediastinal masses were large (the mean diameter was 10.8 cm) and located anteriorly (prevascularly). They contained low-attenuation areas and were often associated with other sites of mediastinal adenopathy. The initial pathologic diagnosis was incorrect for eight patients (40%). Mediastinal large-cell lymphoma can be added to the differential diagnosis of a large anterior mediastinal mass with obstruction of the superior vena cava.