{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T02:11:48Z","timestamp":1769652708341,"version":"3.49.0"},"reference-count":32,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T00:00:00Z","timestamp":1769472000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Reports"],"abstract":"<jats:p>Background and Clinical Significance: Mantle cell lymphoma (MCL) frequently involves bone marrow, gastrointestinal tract, and hepatosplenomegaly, whereas pleural effusions are uncommon. Cases requiring invasive mechanical ventilation and thoracic drainage are rare. We report a case of MCL with persistent massive pleural effusions requiring invasive mechanical ventilation and bilateral continuous thoracic drainage. Case Presentation: A 71-year-old woman presented with dyspnea and was found to have bilateral pleural effusions and generalized lymphadenopathy. Shortly after admission, she developed acute respiratory failure due to pleural effusions and required invasive mechanical ventilation. Right-sided continuous thoracic drainage was initiated. Thereafter, more than 1 L of pleural fluid was drained each day. Flow cytometry of the pleural fluid showed CD5-positive B cells with kappa light-chain restriction. Bone marrow examination revealed abnormal lymphocyte infiltration. Cervical lymph node biopsy demonstrated diffuse proliferation of medium-sized, abnormal B lymphocytes with an immunophenotype of CD5+, CD19+, CD20+, cyclin D1+, SOX11+, and \u03ba+, with a Ki-67 index of 20%, confirming MCL, stage IV. Immunochemotherapy with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) was commenced under mechanical ventilation. Shortly thereafter, left-sided continuous thoracic drainage was also initiated. However, in response to immunochemotherapy, the bilateral pleural effusions gradually subsided, enabling extubation, and there was no reaccumulation after removal of both chest tubes. Furthermore, generalized lymphadenopathy regressed, and bone marrow examination revealed resolution of lymphoma infiltration, resulting in complete remission. Conclusions: De novo MCL complicated by persistent massive pleural effusions requiring invasive mechanical ventilation and bilateral continuous thoracic drainage is rare. A thorough diagnostic workup followed by prompt initiation of immunochemotherapy can arrest pleural output, enable extubation, and be lifesaving. Clinicians should recognize that MCL rarely presents with persistent massive pleural effusions.<\/jats:p>","DOI":"10.3390\/reports9010038","type":"journal-article","created":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T10:27:11Z","timestamp":1769509631000},"page":"38","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Mantle Cell Lymphoma with Persistent Massive Pleural Effusions Requiring Invasive Mechanical Ventilation and Bilateral Continuous Thoracic Drainage"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7127-8582","authenticated-orcid":false,"given":"Taichiro","family":"Tokura","sequence":"first","affiliation":[{"name":"Department of Hematology, Tokyo Metropolitan Tama-Hokubu Medical Center, 1-7-1 Aoba-cho, Higashimurayama-shi, Tokyo 189-0002, Japan"},{"name":"Department of Hematology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8602, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Youhei","family":"Imai","sequence":"additional","affiliation":[{"name":"Department of Hematology, Tokyo Metropolitan Tama-Hokubu Medical Center, 1-7-1 Aoba-cho, Higashimurayama-shi, Tokyo 189-0002, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Satoshi","family":"Sakai","sequence":"additional","affiliation":[{"name":"Department of Hematology, Tokyo Metropolitan Tama-Hokubu Medical Center, 1-7-1 Aoba-cho, Higashimurayama-shi, Tokyo 189-0002, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Reina","family":"Saga","sequence":"additional","affiliation":[{"name":"Department of Hematology, Tokyo Metropolitan Tama-Hokubu Medical Center, 1-7-1 Aoba-cho, Higashimurayama-shi, Tokyo 189-0002, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroko","family":"Hidai","sequence":"additional","affiliation":[{"name":"Department of Hematology, Tokyo Metropolitan Tama-Hokubu Medical Center, 1-7-1 Aoba-cho, Higashimurayama-shi, Tokyo 189-0002, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6960-0800","authenticated-orcid":false,"given":"Sayuri","family":"Motomura","sequence":"additional","affiliation":[{"name":"Department of Hematology, Tokyo Metropolitan Tama-Hokubu Medical Center, 1-7-1 Aoba-cho, Higashimurayama-shi, Tokyo 189-0002, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3652","DOI":"10.1182\/bloodadvances.2023011763","article-title":"Biological and clinical determinants shaping heterogeneity in mantle cell lymphoma","volume":"8","author":"Silkenstedt","year":"2024","journal-title":"Blood Adv."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1229","DOI":"10.1182\/blood.2022015851","article-title":"The International Consensus Classification of Mature Lymphoid Neoplasms: A report from the Clinical Advisory Committee","volume":"140","author":"Campo","year":"2022","journal-title":"Blood"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1002\/hon.3149","article-title":"Mantle cell lymphoma-Update on molecular biology, prognostication and treatment approaches","volume":"41","author":"Silkenstedt","year":"2023","journal-title":"Hematol. Oncol."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Jerkeman, M., Aurer, I., Campo, E., Cheah, C.Y., Clark, J., Doorduijn, J., Eyre, T.A., Fehr, M., Gin\u00e9, E., and Gomes da Silva, M. (2025). EHA-EU MCL network guidelines for diagnosis and treatment of mantle cell lymphoma. HemaSphere, 9.","DOI":"10.1002\/hem3.70233"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1002\/cncr.11096","article-title":"Frequency of gastrointestinal involvement and its clinical significance in mantle cell lymphoma","volume":"97","author":"Romaguera","year":"2003","journal-title":"Cancer"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2067","DOI":"10.1182\/blood.V89.6.2067","article-title":"Mantle cell lymphoma: A clinicopathologic study of 80 cases","volume":"89","author":"Argatoff","year":"1997","journal-title":"Blood"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1693","DOI":"10.1007\/s00261-015-0389-9","article-title":"MDCT of extranodal mantle cell lymphoma: A single institute experience","volume":"40","author":"Baheti","year":"2015","journal-title":"Abdom. Imaging"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1497","DOI":"10.5858\/2006-130-1497-LITPAC","article-title":"Lymphomas involving the pleura: A clinicopathologic study of 34 cases diagnosed by pleural biopsy","volume":"130","author":"Vega","year":"2006","journal-title":"Arch. Pathol. Lab. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"710","DOI":"10.1002\/ajh.25487","article-title":"Mantle cell lymphoma: 2019 update on the diagnosis, pathogenesis, prognostication, and management","volume":"94","author":"Jain","year":"2019","journal-title":"Am. J. Hematol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1419","DOI":"10.1182\/blood.2020005289","article-title":"Genomic and epigenomic insights into the origin, pathogenesis, and clinical behavior of mantle cell lymphoma subtypes","volume":"136","author":"Nadeu","year":"2020","journal-title":"Blood"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1182\/blood-2007-06-095331","article-title":"A new prognostic index (MIPI) for patients with advanced-stage mantle cell lymphoma","volume":"111","author":"Hoster","year":"2008","journal-title":"Blood"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1386","DOI":"10.1200\/JCO.2015.63.8387","article-title":"Prognostic Value of Ki-67 Index, Cytology, and Growth Pattern in Mantle-Cell Lymphoma: Results From Randomized Trials of the European Mantle Cell Lymphoma Network","volume":"34","author":"Hoster","year":"2016","journal-title":"J. Clin. Oncol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"984","DOI":"10.1200\/JCO.18.00605","article-title":"First-Line Treatment of Patients With Indolent Non-Hodgkin Lymphoma or Mantle-Cell Lymphoma With Bendamustine Plus Rituximab Versus R-CHOP or R-CVP: Results of the BRIGHT 5-Year Follow-Up Study","volume":"37","author":"Flinn","year":"2019","journal-title":"J. Clin. Oncol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2482","DOI":"10.1056\/NEJMoa2201817","article-title":"Ibrutinib plus Bendamustine and Rituximab in Untreated Mantle-Cell Lymphoma","volume":"386","author":"Wang","year":"2022","journal-title":"N. Engl. J. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1159\/000539288","article-title":"Gastrointestinal Symptom-Free Multiple Lymphomatous Polyposis: An Atypical Case Presentation of Mantle Cell Lymphoma","volume":"18","author":"Desai","year":"2024","journal-title":"Case Rep. Gastroenterol."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Obregon, M., Kohli, A., and Song, M. (2023). Mantle Cell Lymphoma Causing Recurrent Pleural Effusions: A Case Report. Cureus, 15.","DOI":"10.7759\/cureus.48945"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1326","DOI":"10.1002\/jha2.580","article-title":"Establishment and characterization of a new mantle cell lymphoma cell line with a NOTCH2 mutation","volume":"3","author":"Safa","year":"2022","journal-title":"Arbo. eJHaem"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1111\/cyt.12532","article-title":"Synchronous mantle cell lymphoma and lung adenocarcinoma presenting in a pleural effusion: A rare tumour combination and a potential pitfall of cytodiagnosis","volume":"29","author":"Kai","year":"2018","journal-title":"Cytopathology"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"114","DOI":"10.4081\/rt.2015.5929","article-title":"Synchronous Pulmonary Malignancies: Atypical Presentation of Mantle Cell Lymphoma Masking a Lung Malignancy","volume":"7","author":"Masha","year":"2015","journal-title":"Rare Tumors"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e21","DOI":"10.1177\/0036933015570528","article-title":"Pericardial, pleural and peritoneal involvement in a patient with primary gastric mantle cell lymphoma","volume":"60","author":"Keklik","year":"2015","journal-title":"Scott. Med. J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"803","DOI":"10.1159\/000346290","article-title":"Massive ascites as the initial manifestation of mantle cell lymphoma: A challenge for the gastroenterologist","volume":"6","author":"Yonal","year":"2012","journal-title":"Case Rep. Gastroenterol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1007\/s10156-011-0308-0","article-title":"Mantle cell lymphoma involvement of the pleura and tuberculous pleurisy with pulmonary tuberculosis: A case report and literature review","volume":"18","author":"Anai","year":"2012","journal-title":"J. Infect. Chemother."},{"key":"ref_23","first-page":"243","article-title":"Ninety-seven Years Old Hispanic Male With Mantle Cell Lymphoma","volume":"2","author":"Thompson","year":"2010","journal-title":"J. Clin. Med. Res."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Cheng, J., Hashem, M.A., Barab\u00e9, F., Cloutier, S., Xi, L., Raffeld, M., Pittaluga, S., and Jaffe, E.S. (2020). CCND1 Genomic Rearrangement as a Secondary Event in High Grade B-Cell Lymphoma. HemaSphere, 5.","DOI":"10.1097\/HS9.0000000000000505"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Castillo, D.R., Park, D., Jeon, W.J., Joung, B., Lee, J., Yang, C., Pham, B., Hino, C., Chong, E., and Shields, A. (2023). Unveiling the Prognostic Significance of BCL6+\/CD10+ Mantle Cell Lymphoma: Meta-Analysis of Individual Patients and Systematic Review. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms241210207"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Loh, Z., Yeh, P., Keane, C., and Hawkes, E.A. (2025). Advances in biomarkers for mantle cell lymphoma in the era of targeted therapies. Haematologica, ahead of print.","DOI":"10.3324\/haematol.2025.288185"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1002\/dc.20432","article-title":"Serous effusions in malignant lymphomas: A review","volume":"34","author":"Das","year":"2006","journal-title":"Diagn. Cytopathol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1309\/AJCP6LXA2LKFZAMC","article-title":"Malignant effusions correlate with poorer prognosis in patients with diffuse large B-cell lymphoma","volume":"143","author":"Chen","year":"2015","journal-title":"Am. J. Clin. Pathol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1007\/s00408-018-0182-y","article-title":"Pleural Effusions in Diffuse Large B-Cell Lymphoma: Clinical and Prognostic Significance","volume":"197","author":"Porcel","year":"2019","journal-title":"Lung"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"van Meerten, T., Kersten, M.J., Iacoboni, G., Hess, G.R., Mutsaers, P.G.N.J., Martin Garcia-Sancho, A.M., Goy, A., Gine, E., Hill, B.T., and Weng, W.K. (2025). Brexucabtagene autoleucel for BTKi-naive relapsed\/refractory mantle cell lymphoma: Primary analysis of ZUMA-2 Cohort 3. Blood, ahead of print.","DOI":"10.1182\/blood.2025029734"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1182\/blood.2023020854","article-title":"Two-year follow-up of lisocabtagene maraleucel in relapsed or refractory large B-cell lymphoma in TRANSCEND NHL 001","volume":"143","author":"Abramson","year":"2024","journal-title":"Blood"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1200\/JCO.23.02470","article-title":"Glofitamab in Relapsed\/Refractory Mantle Cell Lymphoma: Results From a Phase I\/II Study","volume":"43","author":"Phillips","year":"2025","journal-title":"J. Clin. Oncol."}],"container-title":["Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2571-841X\/9\/1\/38\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T09:16:44Z","timestamp":1769591804000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2571-841X\/9\/1\/38"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,27]]},"references-count":32,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["reports9010038"],"URL":"https:\/\/doi.org\/10.3390\/reports9010038","relation":{},"ISSN":["2571-841X"],"issn-type":[{"value":"2571-841X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,27]]}}}