PMC3314538_01
The patient's clinical presentations;neck mass (A), axillary freckles (B), cafe-au-lait macules (C), and neurofibroma (D).
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F1
Horner's syndrome. His skin examination disclosed several dermatologic signs such as multiple well-defined brownish cafe au lait patches on the abdomen, areolae, arms, back and buttocks, and axillary freckles (Figure 1).
Chest X-ray revealed a large anterior mediastinal mass.
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F2
Chest X-ray revealed a large anterior mediastinal mass (Figure 2).
Computed tomography (CT) of the neck and chest showed a large lobulated heterogeneous-enhancing mass with central necrosis at the anterior and the middle mediastinum with some parts extending into the left anterior neck (A). Significant improvement of lymphomatous involvement at the prevascular region was seen after eight cycles of CHOP chemotherapy (B). CHOP, Cyclophosphamide (Cytoxan), Hydroxyrubicin (Adriamycin), Oncovin (Vincristine), Prednisone.
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F3
Computed tomography (CT) of the chest disclosed a large (10.9 x 9.7 x 18 cm) lobulated heterogeneous-enhancing mass with a central necrosis in the anterior and middle mediastinum which extended superiorly into the left anterior neck (C5-C6 level), and encased around his aortic arch, left subclavian artery, left jugular vein, trachea, left main bronchus and left pulmonary artery (Figure 3A). Once the diagnosis and the staging were completed, he was treated with the standard CHOP (Cyclophosphamide (Cytoxan), Hydroxyrubicin (Adriamycin), Oncovin (Vincristine), Prednisone) chemotherapy regimen for eight cycles, to which the tumor responded well (Figure 3B).