# Rapid Response of Mediastinal Lymphoma to Corticosteroids During Diagnostic Evaluation: A Clinical Case Report

## TL;DR

A young man with non-Hodgkin's lymphoma showed rapid tumor regression after steroid treatment before starting chemotherapy.

## Contribution

This case report highlights the unexpected rapid response of a mediastinal lymphoma to corticosteroids during diagnostic evaluation.

## Key findings

- The patient showed regression in the mediastinal tumor size after steroid therapy before chemotherapy.
- T-cell lymphoblastic lymphoma commonly presents with mediastinal masses and pleural effusion.
- Prognostic factors for T-LBL include age, pleural effusion, and extranodal involvement.

## Abstract

Here, we report a case of non-Hodgkin's lymphoma in a 21-year-old man who presented with symptoms of gastric discomfort, hematemesis, breathlessness, dry cough, chest pain, loss of appetite, and weight loss. He had a history of pleural effusion and was previously diagnosed with tuberculosis. Further investigations revealed a mediastinal mass. A biopsy confirmed non-Hodgkin's lymphoma and ruled out thymoma. The patient underwent therapeutic thoracentesis for symptomatic relief and was started on chemotherapy. The prognosis of T-cell lymphoblastic lymphoma (T-LBL) is generally poorer compared to B-cell lymphoblastic lymphoma (B-LBL). T-LBL commonly presents with a mediastinal mass and pleural effusion. Imaging techniques like computed tomography (CT) help evaluate the extent and characteristics of the tumor. Prognostic factors for T-LBL include age, pleural effusion, and extranodal involvement. Molecular characterization is important in determining prognosis and treatment options. 18F-FDG imaging can assist in determining the extent of the tumor, staging, and assessment of response to treatment. Overall, lymphoblastic lymphoma is a rare entity, and T-LBL accounts for a small percentage of all lymphomas. Before the start of definitive chemotherapy, during the evaluation, the patient was started on steroid therapy for symptomatic management, following which regression in the size of the mediastinal tumor was noted.