Mediastinal syndrome from plasmablastic lymphoma in human immunodeficiency virus and human herpes virus 8 negative patient with polycythemia vera: a case report.
BACKGROUND
Plasmoblastic lymphoma is a rare and aggressive subtype of diffuse large B cell lymphoma, which occurs usually in the jaw of immunocompromised subjects.


METHODS
We describe the occurrence of plasmoblastic lymphoma in the mediastinum and chest wall skin of an human immunodeficiency virus-negative 63-year-old Caucasian man who had had polycytemia vera 7 years before. At admission, the patient showed a superior vena cava syndrome, with persistent dyspnoea, cough, and distension of the jugular veins. Imaging findings showed a 9.7 × 8 × 5.7 cm mediastinal mass. A chest wall neoformation biopsy and ultrasound-guided fine-needle aspiration biopsy of the mediastinal mass allowed diagnosis of plasmoblastic lymphoma and establishment of an immediate chemotherapeutic regimen, with rapid remission of compression symptoms.


CONCLUSIONS
Plasmoblastic lymphoma is a very uncommon, difficult to diagnose, and aggressive disease. The presented case represents the first rare mediastinal plasmoblastic lymphoma in a human immunodeficiency virus-/human herpesvirus-8-negative patient. Pathologists should be aware that this tumor does appear in sites other than the oral cavity. Fine-needle aspiration biopsy is a low-cost, repeatable, easy-to-perform technique, with a high diagnostic accuracy and with very low complication and mortality rates. Fine-needle aspiration biopsy could represent the right alternative to surgery in those patients affected by plasmoblastic lymphoma, being rapid and minimally invasive. It allowed establishment of prompt medical treatment with subsequent considerable reduction of the neoplastic tissue and resolution of the mediastinal syndrome.
Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Via Del Vespro 129, 90127, Palermo, Italy.
Massimo
M
Cajozzo
Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Via Del Vespro 129, 90127, Palermo, Italy. vincenzodavide.palumbo@unipa.it.|Euro-Mediterranean Institute of Science and Technology (IEMEST), Palermo, Italy. vincenzodavide.palumbo@unipa.it.
Vincenzo Davide
VD
Palumbo
Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Via Del Vespro 129, 90127, Palermo, Italy.
Salvatore
S
Buscemi
Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Via Del Vespro 129, 90127, Palermo, Italy.
Giuseppe
G
Damiano
Department of Science for Health Promotion and for Mother and Child "G. D'Alessandro", University of Palermo, Palermo, Italy.
Ada Maria
AM
Florena
Department of Science for Health Promotion and for Mother and Child "G. D'Alessandro", University of Palermo, Palermo, Italy.
Daniela
D
Cabibi
Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Via Del Vespro 129, 90127, Palermo, Italy.
Francesco
F
Raffaele
Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Via Del Vespro 129, 90127, Palermo, Italy.
Antonino Alessio
AA
Anzalone
Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Via Del Vespro 129, 90127, Palermo, Italy.
Federica
F
Fatica
Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Via Del Vespro 129, 90127, Palermo, Italy.
Gerlando
G
Cocchiara
Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Via Del Vespro 129, 90127, Palermo, Italy.
Salvatore
S
Dioguardi
Department of Diagnostic Medicine and Prevention, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
Antonio
A
Bruno
Mediterranean Oncological Institute (IOM), Catania, Italy.
Francesco Paolo
FP
Caronia
Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Via Del Vespro 129, 90127, Palermo, Italy.
Attilio Ignazio
AI
Lo Monte
D044963:Biopsy, Fine-Needle; D003371:Cough / Q000209:etiology; D004417:Dyspnea / Q000209:etiology; D018023:HIV Seronegativity; D006566:Herpesviridae Infections / Q000175:diagnosis / Q000628:therapy; D019288:Herpesvirus 8, Human; D006801:Humans; D007601:Jugular Veins / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D008479:Mediastinal Neoplasms / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D008482:Mediastinum / Q000473:pathology*; D008875:Middle Aged; D000069293:Plasmablastic Lymphoma / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D011087:Polycythemia Vera / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D013577:Syndrome; D013927:Thrombosis / Q000000981:diagnostic imaging* / Q000628:therapy; D016896:Treatment Outcome; D014463:Ultrasonography
Case report; Fine-needle aspiration biopsy; Hematology; Rare clinical case; Thoracic surgery