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T-Cell Lymphoblastic Lymphoma Presenting as Acute Clavicular Pain
Cody Tidwell1,2, April Willman3
1University of South Dakota Sanford School of Medicine.
Summary
A pediatric patient with an anterior mediastinal mass, diagnosed as T-cell lymphoblastic lymphoma, experienced supraclavicular pain. Treatment involved chemotherapy, with the patient responding well and currently in the consolidation phase.
Area of Science:
- Pediatric Oncology
- Hematology
- Thoracic Surgery
Background:
- Anterior mediastinal masses present a wide differential diagnosis in pediatric patients.
- Early diagnosis and management are crucial for favorable outcomes.
Observation:
- A pediatric case presented with a large anterior mediastinal malignancy causing left-sided supraclavicular pain.
- Computed Tomography (CT) imaging identified the mass, and a supraclavicular lymph node biopsy confirmed T-cell lymphoblastic lymphoma.
Findings:
- The patient received initial treatment with methylprednisolone for cytoreduction and rasburicase/allopurinol for tumor lysis syndrome.
- A 34-day induction chemotherapy phase included vincristine, daunorubicin, PEG-asparaginase, and intrathecal methotrexate.
- Cerebrospinal fluid (CSF) sampling and bone marrow biopsies were negative post-induction.
Implications:
- This case highlights the importance of considering lymphoma in pediatric anterior mediastinal masses presenting with atypical symptoms.
- Successful management involves prompt diagnosis, cytoreduction, and multi-agent chemotherapy.
- The patient's current well-tolerated status in the consolidation phase suggests a positive treatment response.
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