A 47-year-old female presented with progressive left-sided facial swelling, exertional dyspnea, and a generalized pruritic rash. Physical examination revealed significant facial edema, cervical lymphadenopathy, and a diffuse maculopapular eruption. Laboratory evaluation demonstrated an absolute eosinophil count of 1.81 x 109/L. Cross-sectional imaging with a computed tomography (CT) scan identified a large anterior mediastinal mass invading the superior vena cava (SVC) and left brachiocephalic vein, supporting the diagnosis of SVC syndrome. Histopathologic evaluation of an ultrasound-guided core cervical lymph node biopsy confirmed classical Hodgkin lymphoma (cHL), nodular sclerosis subtype. This case highlights an uncommon initial presentation of cHL characterized by the convergence of SVC syndrome, eosinophilia, and a paraneoplastic pruritic rash in the absence of classic B symptoms. Prompt identification of these atypical manifestations must be reconciled with the broader clinical context to avoid delays in diagnosis and treatment. Furthermore, this case emphasizes the necessity of obtaining a definitive tissue diagnosis before initiating corticosteroid therapy, which can mask lymphoproliferative architecture and obscure pathologic findings.

Lung malignancy presenting as empyema is a rare presentation, which is commonly associated with infection. We report two patients initially diagnosed with tuberculosis-associated pleural disease who were subsequently confirmed to have lung malignancy. The first case involved a woman in her 40s presenting with progressive dyspnea, hydropneumothorax, persistent exudative pleural drainage, and prolonged air leak despite anti-tuberculosis therapy. Repeated cytological and microbiological examinations were negative, while persistently low pleural adenosine deaminase (ADA) levels and lack of clinical improvement prompted thoracotomy biopsy, which confirmed adenocarcinoma. The second case involved a man in his 40s presenting with persistent empyema during tuberculosis treatment. Despite thoracotomy and decortication, the patient continued to develop progressive respiratory and systemic symptoms. Subsequent imaging demonstrated a chest wall mass and vertebral lytic lesions suggestive of metastatic disease, while histopathological examination confirmed squamous cell carcinoma. A systematic search of PubMed, Cochrane, ProQuest, and Wiley databases up to May 5, 2026, identified eight published cases of lung malignancy presenting as empyema. Clinical presentation was frequently non-specific, although several patients exhibited red flag features such as hemoptysis, weight loss, and anorexia. Laboratory findings were not sufficiently specific to distinguish malignancy-associated empyema from infectious etiologies. Computed tomography frequently revealed findings suggestive of underlying malignancy, including lung masses, mediastinal lymphadenopathy, bronchial obstruction, and invasion into adjacent structures. Initial investigations commonly supported an infectious diagnosis, while a definitive diagnosis was consistently established only after invasive tissue biopsy. Malignancy-associated empyema represents an important diagnostic pitfall, particularly in tuberculosis (TB)-endemic settings where infectious etiologies are strongly favored. Persistent or non-resolving empyema with atypical clinical, biochemical, or radiological findings should prompt early tissue biopsy to avoid delayed oncologic diagnosis and treatment.

Esophageal sarcoma is an extremely rare tumor, and a recommended treatment strategy remains unestablished. The present report describes, to the best of our knowledge, the first reported case of unresectable esophageal sarcoma treated with chemoradiotherapy (CRT) followed by salvage robot-assisted minimally invasive esophagectomy (RAMIE). An 82-year-old man presented with dysphagia for solid foods. An esophagogastroduodenoscopy revealed an elevated tumor in the middle thoracic esophagus at a distance of 30-35 cm from the incisors, with preserved endoscopic passage and no additional lesions in the stomach or duodenum. A biopsy demonstrated sarcoma. Enhanced computed tomography showed a middle thoracic esophageal mass, with bulky mediastinal lymph nodes (nos. 101R and 106recR) invading the trachea. No distant metastases were detected, and tumor marker levels remained within normal limits. The patient was diagnosed with esophageal sarcoma with mediastinal lymph node metastases. As the metastatic nodes demonstrated airway invasion, definitive CRT (dCRT) was selected. The regimen consisted of radiotherapy (50.4 Gy in 28 fractions) and fluorouracil plus cisplatin. Following dCRT, the tumor and lymph nodes decreased in size, and a partial response was achieved, making the tumor resectable. Salvage RAMIE with two-field lymphadenectomy, including cervical lymph node dissection of stations 101R and 101L and upper mediastinal dissection, including station 106recR, was subsequently performed, followed by gastric tube reconstruction via the posterior mediastinal route. Pathological examination of the resected specimen revealed no residual tumor. Although a therapeutic effect was observed, a limitation remains in that a definitive diagnosis could not be fully established. A total of 14 months have passed since the initiation of treatment, with no evidence of recurrence. In conclusion, this patient with unresectable locally advanced esophageal sarcoma achieved a complete pathological response after multidisciplinary treatment, with no recurrence observed during the short-term follow-up period.

Primary cardiac lymphoma is an exceptionally rare extranodal non-Hodgkin lymphoma that often presents with non-specific cardiopulmonary symptoms, resulting in delayed diagnosis. Superior vena cava (SVC) syndrome as the initial manifestation is particularly uncommon and may mimic more prevalent conditions such as thrombosis, mediastinal malignancy, or right atrial myxoma. We report a case of a 37-year-old immunocompetent woman who presented with progressive breathlessness, facial puffiness, distended neck veins, and upper limb edema for two weeks. Initial Doppler evaluation suggested internal jugular venous thrombosis with distal obstruction, and anticoagulation therapy was initiated. However, persistent symptoms prompted further evaluation. Transthoracic echocardiography demonstrated a large homogeneous right atrial mass extending into the coronary sinus, while computed tomography revealed a non-enhancing mass occupying the right atrium with extension into the superior vena cava. Cardiac magnetic resonance imaging was inconclusive. Given persistent symptoms and uncertainty regarding the diagnosis, surgical exploration with biopsy was performed. Histopathological examination with immunohistochemistry confirmed diffuse large B-cell lymphoma with CD20 and CD30 positivity, establishing primary cardiac lymphoma. This case highlights the variable presentation of primary cardiac lymphoma and the limitations of imaging in differentiating malignant cardiac masses from thrombus. Although uncommon, primary cardiac lymphoma should be considered in patients with unexplained SVC syndrome, particularly when anticoagulation fails or imaging demonstrates right atrial involvement. Early tissue diagnosis is essential, as prompt initiation of chemotherapy may improve outcomes in this aggressive yet potentially treatable malignancy.

Primary pulmonary inflammatory myofibroblastic tumor (IMT) associated with paraneoplastic pemphigus (PNP) is extremely rare. IMT is an intermediate (rarely metastasizing) mesenchymal neoplasm rather than a conventional sarcoma. We report a case of a 68-year-old female patient who initially presented with generalized skin rash, oral mucosal ulceration, and fever. Chest CT revealed a thoracic mass (initially difficult to determine whether mediastinal or pulmonary in origin). Subsequent thoracotomy and surgical resection with pathological examination confirmed an ALK-rearranged inflammatory myofibroblastic tumor (SQSTM1: ALK fusion) of pulmonary origin. Oral mucosal pathology, combined with clinical findings, supported a diagnosis of PNP. This case aims to provide reference for the diagnosis and treatment of patients with primary pulmonary IMT complicated by PNP. However, the follow-up period was short and systemic immunosuppressive therapy was not administered; this should be regarded as a cautionary note rather than a therapeutic recommendation.

Kaposiform hemangioendothelioma (KHE) is a rare borderline vascular tumor that occurs primarily during infancy and childhood. The tumor typically originates in the skin and exhibits invasive growth into deeper tissues, often manifesting as a firm, poorly defined purplish-red mass. Cases of KHE involving visceral organs, including the bone, retroperitoneum, or mediastinum, have also been reported; however, their clinical features are often nonspecific, which may lead to delayed diagnosis. Importantly, these tumors are frequently associated with Kasabach-Merritt phenomenon, a consumptive coagulopathy that represents a major cause of mortality in KHE. Furthermore, tumor location, size, and clinical response to pharmacotherapy are closely associated with patient prognosis. Therefore, early recognition and timely treatment of KHE are essential. This article aims to review the epidemiology, etiology, clinical manifestations, diagnosis, and management of KHE.

BackgroundGastrointestinal metastases from primary lung malignancies occur in 0.2-11.9% of autopsy series; symptomatic colonic involvement is exceedingly rare (0.1%), portending a dismal prognosis with a reported median survival of approximately 2 months.Case PresentationA 60-year-old woman with a 40 pack-year smoking history, chronic obstructive pulmonary disease, and prior cervical malignancy presented with a refractory acute exacerbation. In the absence of a discrete pulmonary parenchymal lesion, computed tomography pulmonary angiography incidentally identified mass-like left upper lobe bronchial wall thickening. Bronchoscopic evaluation revealed high-grade endobronchial stenosis. Mediastinal fine-needle aspiration confirmed non-small cell lung carcinoma; colonic metastases identified on staging PET-CT demonstrated TTF-1/Napsin-A positivity with a CK7+/CK20-/CDX2- immunophenotype, consistent with pulmonary adenocarcinoma. Sequential adrenal resection revealed divergent squamous differentiation (p40+/CK5/6+; TTF-1-/Napsin-A-) with KRAS/MYC and NF-1 amplification, supporting a final diagnosis of pulmonary adenosquamous carcinoma-an aggressive NSCLC variant comprising 0.4-4% of lung malignancies.Management and OutcomeTreatment followed evidence-based, histology-guided sequencing: concurrent carboplatin-pemetrexed chemoradiation, nivolumab upon platinum resistance, and cytotoxic salvage with docetaxel followed by vinorelbine. Palliative adrenalectomy addressed refractory pain. The patient survived 42 months from diagnosis, the clinical course was shaped by adequate tissue sampling, diagnostic challenges, and multidisciplinary histology-guided treatment acquisition.ConclusionThis case underscores the diagnostic and therapeutic complexity of lung adenocarcinoma presenting with synchronous colonic metastases without a discrete parenchymal mass, compounded by intratumoral heterogeneity and phenotypic divergence across metastases. Comprehensive tissue sampling enabling serial immunohistochemical and molecular characterization, coupled with coordinated multidisciplinary management, is essential to optimize diagnostic accuracy and therapeutic sequencing in this rare and clinically challenging disease entity.

Background: Thromboembolism is a serious complication in acute lymphoblastic leukemia (ALL). This systematic review and meta-analysis evaluated thrombosis incidence and risk factors across populations receiving asparaginase-based therapy. Methods: From 214 studies (1994-2026), 58 met inclusion criteria, totaling 23,655 adult, pediatric, and mixed-population patients. Searches included Ovid MEDLINE, Embase, Cochrane CENTRAL, PubMed Central, and Google Scholar. Eligible studies were observational cohorts or clinical trials reporting thrombosis in ALL patients treated with asparaginase. Risk factors assessed included study design, asparaginase formulation, immunophenotype, gender, treatment phase, corticosteroid use, mediastinal mass, ABO blood group, body weight, and age. Random-effects models were used for meta-analysis, and risk of bias was assessed using ROBINS-I and RoB-2. Results: Adults had significantly higher thrombosis rates than children (p < 0.0001). Study design, asparaginase formulation, immunophenotype, and treatment phase differed significantly across age groups (p < 0.0001). T-cell ALL showed higher thrombosis rates than B-cell ALL (p < 0.0001). Significant pediatric risk factors included age ≥ 10 years, mediastinal mass, non-O blood type, and overweight/obesity (all p ≤ 0.0004). Gender and corticosteroid use were not significant predictors. Findings were limited by substantial heterogeneity across included studies. Conclusions: Thrombosis risk was multifactorial. Adults and older children had higher risk, and pediatric patients with overweight/obesity, mediastinal mass, or non-O blood type were particularly vulnerable. Thromboprophylaxis is advised for high-risk groups. This review was not registered and received no external funding.

A 75-year-old man presented to our hospital with fever and bloody sputum. Chest computed tomography revealed a mass lesion occupying the left lower lobe with surrounding infiltrative shadows. 18F-fluoro-2-deoxy-glucose positron emission tomography demonstrated high 18F-fluoro-2-deoxy-glucose uptake in the pulmonary mass, left hilar lymph nodes, and right mediastinal lymph node. Transbronchial biopsy confirmed squamous cell carcinoma. The patient was diagnosed with clinical stage IIIC non-small cell lung cancer, and chemoradiotherapy was planned. However, 21 days after the biopsy, he developed acute empyema. Decortication was successfully performed by video-assisted thoracic surgery. Postoperatively, the antimicrobial agent was switched from meropenem hydrate to linezolid after methicillin-resistant Staphylococcus aureus was detected in the pleural effusion culture. The chest tubes were removed 7 days after surgery, and the patient was discharged 1 month after surgery. Chest computed tomography at 1.5 months postoperatively showed no recurrence of empyema, and chemotherapy for advanced non-small cell lung cancer was initiated.