Fluid Overload-Associated Large B-Cell Lymphoma: Two Case Report and Review of Literature

Liu DI Chang^1,2Zhaobo Yang²Cuicui Yang²Yuxiao Wang^1,2Dan Li^1,2Hui Wang^1,2LANLAN ZANG^2*Yuanyuan Zhang^2*

• ¹Shandong Second Medical University, Weifang, China
• ²Linyi People's Hospital, Linyi, China

Fluid overload–associated large B-cell lymphoma (FO-LBCL) is a rare lymphoma that primarily involves serous body cavities (pleural, peritoneal, and pericardial spaces) without forming solid masses. Because FO-LBCL is uncommon, patients typically present with nonspecific symptoms—most frequently dyspnea from effusion—hindering early recognition and diagnosis. This study presents two cases of FO-LBCL and reviews the clinical characteristics, treatment regimens, and prognosis of 57 patients with FO-LBCL. Results showed that serous effusions involved the pleural cavity in 84.2% of cases, the pericardial cavity in 31.6%, and the peritoneal cavity in 21.1%. The most frequent presenting symptom was dyspnea (55.8%); other reported symptoms included chest tightness, gastric discomfort, fatigue, and lower-limb edema, reflecting respiratory, gastrointestinal, circulatory, and systemic involvement. Chemotherapy was the primary treatment (56.1%), most commonly the R-CHOP regimen. Univariate analysis identified the following factors as significantly associated with outcome: CD20 expression (P = 6 × 10-7), absence of CD138 expression (P = 0.0009), age > 65 years (P = 0.0015), LDH ≤500 U/L (P = 0.0064), presence of pleural effusion (P = 0.0099), CD79a expression (P = 0.0395), and use of rituximab-containing chemotherapy regimens (P = 0.0049). Our objectives are to characterize FO-LBCL comprehensively, clarify its differential diagnosis and management options, and address current gaps in clinical knowledge about this entity.