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CC BY-NC-ND 4.0 · Indian J Med Paediatr Oncol 2021; 42(02): 208-212
DOI: 10.1055/s-0041-1732819
Case Report with Review of Literature

Managing Life-Threatening Malignant Superior Mediastinal Syndrome in Pregnancy: When Benefits of Radiation and Chemotherapy Outweigh the Risks—A Case Report and Review of Literature

Aashima Arora
1   Department of Obstetrics and Gynaecology, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
,
Gaurav Prakash 
2   Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
,
Rashmi Bagga
1   Department of Obstetrics and Gynaecology, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
,
Radhika Srinivasan
3   Department of Cytopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
,
Arihant Jain 
2   Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
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Abstract

There is scarce literature on managing superior mediastinal syndrome during pregnancy. We report a case of 26-year-old primigravida who presented with life-threatening superior mediastinal syndrome at 32 weeks of gestation. The diagnosis was significantly delayed and, as a result, she reached the emergency with stridor and impending respiratory failure. She was diagnosed with primary mediastinal B cell lymphoma Lugano Stage II with a bulky mediastinal mass. She was treated with chemoimmunotherapy and underwent a preterm vaginal delivery after a week. She delivered a 1.6 kg healthy child with no malformations. Later, she completed three cycles of rituximab, cyclophosphamide, vincristine, doxorubicin, and prednisolone and five cycles of dose-adjusted etoposide, prednisolone, vincristine, cyclophosphamide, doxorubicin, rituximab, followed by radiotherapy. She continues to be in remission at 18 months of follow-up. Delaying diagnostic imaging that involves ionizing radiation exposure and chemotherapy to avoid teratogenic and obstetric complications during pregnancy can adversely affect the prognosis in certain patients with high-grade malignancies. On the contrary, prompt multidisciplinary management can lead to a gratifying outcome.

Keywords

pregnancy - lymphoma - radiation - chemotherapy


Publication History

Article published online:
06 August 2021

© 2021. Indian Society of Medical and Paediatric Oncology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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