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Washington University Experience | NEOPLASMS (HEMATOLYMPHOID) | Lymphoma, secondary | 14A0 Case 14 History
Case 14 History ---- The decedent was a 90 year old woman with a history of diffuse large B-cell lymphoma, non-germinal center type in the right eyelid, diagnosed 9 years previously and treated with R-CHOP and consolidative radiotherapy. Her condition was subsequently complicated by potential recurrence with lesions in the brainstem, pelvis, and mediastinum who presented to OSH#1 in early June 2025 with acute right-sided facial droop, slurred speech, and right-sided weakness thought to be an infarct; however, the patient left before further testing could be conducted. Later that month, she presented to OSH#2 with slurred speech and worsening right-sided weakness. A brain MRI revealed several intracranial masses, one consistent with a meningioma, and she was transferred to BJH, where she was hospitalized from 6/25 -7/4. Additional imaging included PET studies (06/26) which showed an intensely avid 2 cm pontine lesion with an SUV of 21, and mild to moderately FDG-avid left obturator, mediastinal, bilateral hilar, and presacral lymphadenopathy (each node <1.0 cm in size). After starting dexamethasone and rehab there was significant improvement of her neurologic deficits. In the evening of July 23rd, the decedent had several episodes of tachypnea followed by feeling drowsy and begin drooling and yawning, previously not part of her symptomatology. She presented to the ED, where a CT scan of the head showed no acute abnormalities. Afterwards, the decedent became hypotensive, was given lactated ringers and norepinephrine, and started on antibiotics after blood cultures were obtained. She was admitted to the ICU for further management, and elected to transition to comfort care, passing away that same day. The general autopsy (limited by permit to several inguinal lymph nodes and the brain) did not show evidence of lymphoma in the sampled nodes.
