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Ann Thorac Surg 2004;78:1888
© 2004 The Society of Thoracic Surgeons

Correspondence

The Diagnostic Approach to Mediastinal Masses

Prasad R. Koduri, MD

Division of Hematology-Oncology, Southern Illinois University School of Medicine, 415 N 9th St, PO Box 19678, Springfield, IL 62794-9678, USA

pkoduri{at}siumed.edu

To the Editor:

Hoerbelt and colleagues [1] proposed that patients with mediastinal masses suspected to be of lymphomatous origin should undergo surgical biopsy because a definitive diagnosis of lymphatic tumors would require large tissue samples. Lymphoblastic lymphoma is an exception in this regard and deserves special mention. It affects children and young adults, who can have a relatively rapid onset of symptoms pointing to the chest, and an anterior mediastinal mass. A high level of serum lactate dehydrogenase together with negative serum markers for alpha-fetoprotein and the ß subunit of human chorionic gonadotropin suggests a diagnosis of lymphoblastic lymphoma. The bone marrow is involved in about a third of the patients [2]. The demonstration of TdT (terminal deoxynucleotidyl transferase)–positive blast cell infiltrate in the bone marrow by flow cytometry or immunohistochemistry establishes the diagnosis of lymphoblastic lymphoma in these patients and can obviate the need of a surgical biopsy.

References

  1. Hoerbelt R, Keunecke L, Grimm H, Schwemmle K, Padberg W. The value of a noninvasive diagnostic approach to mediastinal masses. Ann Thorac Surg. 2003;75:1086–1090[Abstract/Free Full Text]
  2. Knowles DM. Lymphoblastic lymphoma. Knowles DM. Neoplastic hematopathology. Philadelphia: Lippincott Williams & Wilkins; 2001. p. 937




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