Fatal Intratumoral Hemorrhage in Mediastinal Diffuse Large B-Cell Lymphoma During Pregnancy: A Case Report

We report a pregnant woman with diffuse large B-cell lymphoma (DLBCL) presenting as a massive mediastinal tumor causing dyspnea. A 34-year-old multiparous woman was diagnosed with the tumor at 16 weeks of gestation. During attempts at airway management using ECMO cannulation and intubation, she developed cardiopulmonary arrest due to airway compromise but was resuscitated. R-CHOP chemotherapy was initiated empirically, and subsequent biopsy confirmed DLBCL, leading to continuation of therapy using DA-EPOCH-R. Despite repeated discussions, including the option of pregnancy termination, the patient strongly wished to continue the pregnancy. Partial tumor shrinkage was achieved; however, at 24 weeks, she developed sudden massive hemoptysis and cardiopulmonary arrest, which proved fatal despite resuscitation. Postmortem imaging demonstrated tumoral hemorrhage with bronchial communication. Although tumoral hemorrhage is a rare complication of lymphoma, it should be recognized as a possible cause of sudden death in malignant disease. This case highlightsthe potential for catastrophic tumoral hemorrhage during chemotherapy and the complex ethical dilemmas surrounding pregnancy continuation.