PDF(Pubmed)
Abstract：
Diffuse large B-cell lymphoma is the most common lymphoma, accounting for 30% of all non-Hodgkin lymphomas; they can grow rapidly and often present as masses infiltrating tissues or obstructing organs. We report the case of a 58-year-old female who presented with a one-month history of generalized body weakness and weight loss with a two-week history of yellowness of the eyes, fever, dyspnea, and bilateral leg swelling. Examination at presentation revealed pallor, fever, jaundice, hepatomegaly, and bilateral pitting pedal edema. Laboratory investigations revealed severe anemia, deranged clotting profile, azotemia, elevated liver enzymes, and elevated tumor markers CA125, CEA, and CA 19.9. Abdominal ultrasound showed hepatomegaly and a large head of the pancreas. The initial diagnosis was obstructive jaundice due to carcinoma of the head of the pancreas. Despite all care offered, her clinical condition deteriorated until she died on the 12th day of admission. A postmortem examination showed a mass in the head of the pancreas and bile duct, enlarged para-aortic and mesenteric lymph nodes with ascites, pericardial nodules, and bronchopneumonia. Histological and immunohistochemical analysis of postmortem biopsies confirmed the diagnosis of a diffuse large B cell lymphoma. This case highlights the diagnostic dilemma often seen in disseminated diffuse large B-cell lymphoma. The patient presented with features referable to different organs and systems. If detected early, most cases respond to standard immuno-chemotherapy. However, it can also become rapidly fatal and ultimately lead to death, as seen in this case.
摘要：
弥漫性大B细胞淋巴瘤是最常见的淋巴瘤,占所有非霍奇金淋巴瘤的30％；它们可以迅速生长，通常以肿块浸润组织或阻塞器官的形式出现。我们报告了一名58岁的女性，她有一个月的全身无力和体重减轻的病史，有两周的眼睛发黄的病史，发烧,呼吸困难,和双侧腿部肿胀。演示时的检查显示苍白，发烧,黄疸,肝肿大,双侧凹陷性踏板水肿。实验室检查显示严重贫血,混乱的凝血特征，氮质血症,肝酶升高，和升高的肿瘤标志物CA125，CEA，和CA19.9。腹部超声显示肝肿大和胰头大。最初的诊断是由于胰头癌引起的阻塞性黄疸。尽管提供了所有的照顾，她的临床病情恶化，直到入院第12天死亡。尸检显示胰头和胆管有肿块，主动脉旁和肠系膜淋巴结肿大伴腹水，心包结节,还有支气管肺炎.死后活检的组织学和免疫组织化学分析证实了弥漫性大B细胞淋巴瘤的诊断。该病例突出了在播散性弥漫性大B细胞淋巴瘤中经常出现的诊断困境。患者具有与不同器官和系统相关的特征。如果早期发现，大多数病例对标准免疫化疗有反应。然而,它也会迅速致命并最终导致死亡，正如在这个案例中看到的。
