Primary mediastinal large B-cell lymphoma diagnostic study of choice

The diagnosis of primary mediastinal lymphoma is primarily based on biopsy findings, followed by immunophenotype and surfae markers.

Biopsy is the diagnostic study of choice.

• The diagnosis of primary mediastinal large B cell lymphoma relies on the exclusion of adequate tissue, which offers most difficulty due to the location of the tumor, therefore an excisional biopsy is usually not possible.
• Therefore, surgical biopsy is highly preferred.^[1]
• Due to fibrosis, needle aspirates are often paucicellular and fail to provide information about the tissue.
• Small biopsies may be non-diagnostic because the lesion is not sampled adequately or because crush artifact or extensive necrosis, fibrosis, or cystic change obscures the diagnostic lesion.
• Similarly, core biopsies mostly contain fibrotic tissue or tumor cells that are disrupted and not useful.
• To obtain sufficient tissue for biopsy , patients usually undergo either one of the following techniques:^[1]
  • Cervical mediastinoscopy
  • Anterior mediastinotomy
  • Thoracoscopy