An odd cause of dysphagia

The incidence of vascular thrombosis has increased since the emergence of intravascular devices such as pacemakers and indwelling catheters used in haemodialysis. 2 However, among oncology patients, thrombosis secondary to indwelling lines is most often caused by central catheters (portacath or Hickman line). Given the most common underlying aetiology (lung cancer), most patients with superior vena cava obstruction have an abnormal chest radiograph, with mediastinal widening and pleural effusions being the most common findings. 4 Contrast enhanced computed tomography enables the level of the obstruction to be identified and often gives information on the cause of the obstruction-whether it is intravascular or extravascular. Lesions in the middle compartment include thyroid tumours, tracheal tumours, and lymphomas. 6 Enlarged lymph nodes in this area may be a consequence of infection, metastatic carcinoma, or sarcoidosis. The histological diagnosis influences the choice of systemic treatment used in non-Hodgkin's lymphoma and non-small cell lung cancers so large tissue samples are needed. The biopsy showed tumour cells with prominent nucleoli and immunohistochemistry in keeping with non-Hodgkin's lymphoma of B cell type. The biopsy showed tumour cells with prominent nucleoli with immunohistochemistry in keeping with non-Hodgkin's lymphoma of B cell type. Non-Hodgkin's lymphoma in general is uncommon in this age group (peak incidence 60-70 years), but this specific type (B cell type) often presents in younger patients. Fig 5 Immunohistochemical staining of lymph node biopsy showing diffuse membrane positivity for CD20 (B cell antigen) in tumour cells. Non-Hodgkin's lymphoma is staged with a modified Ann Arbor classification...