Clinical Report: Rapidly Expanding Perigraft Hematoma Linked to Chronic Inflammation

Overview

This case study presents a rare instance of diffuse large B-cell lymphoma associated with chronic inflammation (DLBCL-CI) occurring around a vascular graft following thoracic endovascular aortic repair (TEVAR). The patient exhibited rapid progression of a periaortic mass, ultimately diagnosed as EBV-positive DLBCL-CI.

Background

Diffuse large B-cell lymphoma associated with chronic inflammation (DLBCL-CI) is a rare subtype of lymphoma that arises in areas of long-standing inflammation, particularly around implants. Its occurrence around vascular grafts is extremely uncommon, with fewer than five cases reported in the literature. Misdiagnosis as benign lesions can lead to delayed treatment.

Data Highlights

No numerical or trial data available in the source material.

Key Findings

• The patient underwent repeat TEVAR for stent-graft fracture 8 years after the initial procedure.
• A periaortic hypodense lesion was initially interpreted as a hematoma but progressed into a large soft-tissue mass.
• Imaging revealed restricted diffusion on MRI and absent enhancement on CEUS.
• Core needle biopsy confirmed EBV-positive DLBCL with a TP53 mutation.
• This case met the criteria of a vascular graft background, EBER positivity, and formation of a well-defined mass.

Clinical Implications

Clinicians should maintain a high index of suspicion for DLBCL-CI in patients with perigraft masses following TEVAR, particularly when imaging findings are discordant with clinical expectations.

Conclusion

This case highlights the need to consider rare malignancies such as DLBCL-CI in the differential diagnosis of perigraft masses post-TEVAR.

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