¹Resident in Internal Medicine Training, Department of Internal Medicine, Unidade Local de Saúde do Oeste – Hospital Caldas da Rainha, Caldas da Rainha, Portugal; ORCID: https://orcid.org/0000-0001-9503-7049.

²Resident in Internal Medicine Training, Department of Internal Medicine, Unidade local de Saúde do Alto Alentejo – Hospital de Portalegre, Portalegre, Portugal, ORCID: https://orcid.org/0000-0002-1994-7849.

³Senior Consultant in Internal Medicine, Casa Santa Maria (RNCCI/ERPI), Lisboa, Portugal; ORCID: https://orcid.org/0000-0003-4448-4169.

Corresponding Author: Sara Lourenço Tereso, Orcid: https://orcid.org/0000- 0001-9503-7049, Rua Diário de Notícias, 2500-176, Caldas da Rainha, Portugal.

Citation: Sara Tereso, Elisabete Mendes, Carlos Machado e Costa (2026). Diffuse Large B Cell Lymphoma with Marked Imaging Response after R CHOP. Euro J Case Rep Clin Imag. 2026; August, e22,1-3.

Copyrights: © Sara Lourenço Tereso, 2026, et al., This article is licensed under the Creative Commons Attribution-Non Commercial-4.0-International-License-(CCBY-NC) (https://europeanjournalofcasereports.com/blogpage/copyright-policy). Usage and distribution for commercial purposes require written permission.

Image Case Presentation:

A 67‑year‑old man with a history of arterial hypertension, dyslipidemia and type II diabetes, who presented to the emergency department with productive cough, asthenia, dyspnea and unquantified weight loss. Chest radiography revealed extensive opacification of the left hemithorax, with mediastinal shift to the contralateral side. Chest computed tomography revealed a large left perihilar mediastinal mass (11 × 7 × 13 cm), causing narrowing of the left main bronchus, occlusion of the left lower lobar bronchus and compression of the pulmonary artery, associated with loculated pleural effusion and multiple supra‑ and infradiaphragmatic lymphadenopathies (Figures 1A, B). Bronchoscopic biopsy confirmed diffuse large B‑cell lymphoma (DLBCL), GCB subtype, stage IV, bulky disease, with R‑IPI 3–4 and CNS‑IPI 4. Emergent R‑CHOP chemotherapy was initiated, with good clinical and laboratory tolerance. After the first cycle, the patient showed significant symptomatic improvement and imaging reduction of the mediastinal mass to 8 × 3.8 cm (Figure 2A, B), along with decreased pleural effusion. Reassessment bronchoscopy demonstrated bronchial patency without the need for endobronchial stenting. The patient remained clinically stable and was discharged home.

Diffuse large B‑cell lymphoma (DLBCL) is the most common histological subtype of non‑Hodgkin lymphoma, with incidence increasing with age [1,2]. Approximately 50% of cases occur in individuals over 65 years old [2]. It may arise de novo or through transformation or progression of indolent lymphomas [2,3]. R‑CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone) is currently the first‑line treatment for DLBCL [2]. Despite its biological heterogeneity, it remains potentially curable with multi‑agent immunochemotherapy [2,3].

Declarations:

Funding: This research received no external funding.

Institutional Review Board Statement: Not applicable.

Informed Consent Statement: Informed consent for publication was obtained from the patient’s legal guardians.

Data Availability Statement: No new data were created or analyzed in this study. Data sharing is not applicable to this article.

Acknowledgments: Not applicable.

Conflicts of Interest: We confirm that there are no conflicts of interest to declare

Reference:

1. Arley F, Kalmus M, Cristaldo N, Ismael I L, Boietti B, Smietniansky S. Impacto f dose intensity in older patients with diffuse large B cell lymphoma. Medicina (Buenos Aires). 2023, 83: 854-856. PMID: 37870356.

2. Kayamori K, Shono K, Onoda M, Yokota A. Efficacy e tolerabilidade do rituximabe e da ciclofosfamida em dose reduzida,Doxorubicina, vincristina e prednisolona para pacientes idosos comdiffuso de linfoma de grandes. Hematology. 2019 Dec, 24(1):52-59. DOI: 10.1080/10245332.2018.1509461.

3. Miura K, Takahashi H, NaKagawa M, Takachi H, Uchino Y, Lizuka K et al. Optimal dose intensity of R-CHOP in diffuse large B-cell lymphomas. Specialist Rev Anticancer Ther. June 2022, 22(6):583-595. DOI: 10.1080/14737140.2022.2071262.