Approach to treating patients with anterior mediastinal tumor causing an oncologic emergency that proved difficult to diagnose: A case report

Abstract

A 12-year-old male was referred to our center for an anterior mediastinal mass with associated symptoms of persistent cough. Computed tomography (CT) revealed a large mediastinal mass compressing the left main bronchus. First, needle biopsy was carried out under local anesthesia owing to the risk of airway obstruction under sedation. The pathological diagnosis was difficult because of the absence of neoplastic features. Open biopsy was performed under general anesthesia after shrinkage of the mass by combination chemotherapy. However, it was still difficult to make a definitive diagnosis. Two months after chemotherapy, the tumor increased in size, and 18F-Fludeoxyglucose-Positron Emission Tomography/Computed Tomography (PET-CT) revealed an abnormal uptake of FDG at the solid part of the mediastinal mass. A third biopsy was performed by thoracotomy, and the site of intense uptake of FDG was resected. Finally, he was diagnosed as having large B-cell lymphoma. It is essential to establish a biopsy protocol that is both safe and reliable, especially for cases of oncologic emergency.