28321070 Visualization

An 84 Age - year Age - old Age woman Sex presented Clinical_event to a local Nonbiological_location clinic Nonbiological_location with dyspnea Sign_symptom on Detailed_description exertion Detailed_description and left Biological_structure back Biological_structure pain Sign_symptom persisting Duration for Duration a Duration month.
She was admitted Clinical_event to our hospital Nonbiological_location because of left Detailed_description pleural Sign_symptom effusion Sign_symptom on a chest Biological_structure X Diagnostic_procedure - ray Diagnostic_procedure .
She suffered hypertension History and dyslipidemia History but had no History history History of History pleural History tuberculosis History or History chronic History pyothorax History , nor History a History smoking History history History or History dust History exposure History .
On examination Diagnostic_procedure , her vital Diagnostic_procedure signs Diagnostic_procedure and oxygen Diagnostic_procedure saturation Diagnostic_procedure were normal Lab_value ( SpO2 Diagnostic_procedure : 96% Lab_value ambient Detailed_description air Detailed_description ).
A chest Diagnostic_procedure examination Diagnostic_procedure revealed a mass Sign_symptom on the left Biological_structure side Biological_structure of Biological_structure her Biological_structure back Biological_structure with pain Sign_symptom and decreased Sign_symptom breathing Sign_symptom sounds Sign_symptom in the left Biological_structure lower Biological_structure - lung Biological_structure field Biological_structure .
The Detailed_description rest Detailed_description of the examination Diagnostic_procedure findings Diagnostic_procedure were normal Lab_value .
Laboratory Diagnostic_procedure tests Diagnostic_procedure revealed elevated Lab_value levels Lab_value of C Diagnostic_procedure reactive Diagnostic_procedure protein Diagnostic_procedure , lactate Diagnostic_procedure dehydrogenase Diagnostic_procedure ( LDH Diagnostic_procedure ), and soluble Diagnostic_procedure interleukin-2 receptor Diagnostic_procedure (sIL-2R) (Table 1).
A chest Biological_structure X Diagnostic_procedure - ray Diagnostic_procedure (Fig.1) showed left Detailed_description pleural Sign_symptom effusion Sign_symptom with mediastinal Detailed_description shift Detailed_description .
On Date the Date first Date hospital Date day Date , an intercostal Biological_structure drainage Therapeutic_procedure tube Therapeutic_procedure was inserted, and after drainage, chest Biological_structure computed Diagnostic_procedure tomography Diagnostic_procedure ( CT Diagnostic_procedure ) (Fig.2) revealed an irregular Detailed_description pleural Biological_structure mass Sign_symptom invading her left Biological_structure chest Biological_structure wall Biological_structure with rib Biological_structure destruction Sign_symptom and pleural Sign_symptom effusion Sign_symptom .
The mass Sign_symptom was adjacent Biological_structure to Biological_structure the Biological_structure posterior Biological_structure mediastinum Biological_structure , but the lateral Detailed_description side Detailed_description of the mass Sign_symptom was thick Detailed_description and invading the chest Biological_structure wall Biological_structure , so we diagnosed this mass Sign_symptom as a chest Disease_disorder wall Disease_disorder tumor Disease_disorder .
The pleural Biological_structure fluid Biological_structure was serous Sign_symptom and not purulent Sign_symptom .
A fluid Diagnostic_procedure analysis Diagnostic_procedure showed it to be exudative Lab_value , and 81% Lab_value of Lab_value the Lab_value white Lab_value blood Lab_value cells Lab_value were Lab_value lymphocytes Lab_value .
The fluid Diagnostic_procedure culture Diagnostic_procedure was negative Lab_value , and cytology Diagnostic_procedure did not show any evidence of malignancy Sign_symptom (Table 1).
CT Detailed_description - guided Detailed_description needle Detailed_description biopsy Diagnostic_procedure was performed.
The histopathology Diagnostic_procedure results supported a diagnosis of diffuse Disease_disorder large Disease_disorder B Disease_disorder - cell Disease_disorder lymphoma Disease_disorder ( DLBCL Disease_disorder ) that was positive Lab_value for CD10 Diagnostic_procedure and CD20 Diagnostic_procedure but negative Lab_value for CD3 Diagnostic_procedure and CD5 Diagnostic_procedure (Fig.3).
18 Diagnostic_procedure - fluorodeoxyglucose Diagnostic_procedure positron Diagnostic_procedure emission Diagnostic_procedure tomography/computed Diagnostic_procedure tomography Diagnostic_procedure ( FDG Diagnostic_procedure - PET/CT Diagnostic_procedure ) revealed high Sign_symptom FDG Sign_symptom uptake Sign_symptom in the left Biological_structure chest Biological_structure wall Biological_structure mass Sign_symptom without any other uptake (Fig.4A and B), so we diagnosed her with primary Disease_disorder malignant Disease_disorder lymphoma Disease_disorder originating Biological_structure from Biological_structure the Biological_structure chest Biological_structure wall Biological_structure .
We reconfirmed her medical history, and she never History had History either History tuberculous History pleurisy History or History pyothorax History .
Her performance Diagnostic_procedure status Diagnostic_procedure ( PS Diagnostic_procedure ) was 3 Lab_value because of her back Biological_structure pain Sign_symptom and fatigue Sign_symptom .
Owing to her bad PS and age, it was difficult to perform an operation or administer combination chemotherapy with Rituximab Medication , so low Detailed_description - dose Detailed_description oral Administration etoposide Medication ( 50 Dosage mg/day Dosage d1 Dosage - 14, Dosage q28 Dosage ) was administered.
Her pleural Sign_symptom effusion Sign_symptom disappeared within Date two Date weeks Date , her back Biological_structure pain Sign_symptom disappeared, and her PS Diagnostic_procedure improved to 1 Lab_value within Date a Date month Date .
Chest Diagnostic_procedure CT Diagnostic_procedure performed four Date months Date later Date showed complete Lab_value response Lab_value (Fig.4C and D).
She continued oral Administration chemotherapy Medication and maintained a good Lab_value PS Diagnostic_procedure for one Date year Date after Date the Date diagnosis Date .