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JAMA Oncology Clinical Challenge
February 2016

Rapidly Appearing Sclerotic Vertebral Lesions in a Patient With an Infiltrative Mediastinal Mass

Author Affiliations
  • 1Department of Oncology, Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota
  • 2Department of Radiology, Mayo Clinic, Rochester, Minnesota
JAMA Oncol. 2016;2(2):267-268. doi:10.1001/jamaoncol.2015.4576

A 48-year-old, previously healthy man presented with a 3-month history of worsening cough, 10-pound weight loss, and fatigue. His physical examination was unremarkable. Chest radiography identified a predominantly anterior mediastinal mass. Contrast-enhanced computed tomography (CT) demonstrated a large infiltrative mediastinal mass involving the anterior and middle mediastinum associated with airway narrowing and severe compression of and probable invasion of the superior vena cava (SVC) and complete obstruction of the left brachiocephalic vein (BCV). Laboratory studies revealed a normocytic anemia and neutrophilia. The patient was referred to a pulmonologist and underwent flexible bronchoscopy with endobronchial ultrasound-guided biopsy. Pathologic review demonstrated an adenocarcinoma with signet-ring features.

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