Rom J Morphol Embryol 2015, 56(4):1541–1543 ISSN (print) 1220–0522 ISSN (on-line) 2066–8279 CASE REPORT Unusual finding of a mediastinal T-cell lymphoma in a 13-year-old patient – a case report RADU NINEL BĂLĂNESCU 1,2) , LAURA BĂLĂNESCU 1,2) , IOAN CORDOŞ 2,3) , DOINIŢA SFRIJAN 2,4) , FLORINEL POP 5) , FLORENTINA-RUXANDRA CARAGAŢĂ 1) , GHEORGHE DAN MĂLĂESCU 6) 1) Department of Pediatric Surgery, “Grigore Alexandrescu” Clinical Emergency Hospital for Children, Bucharest, Romania 2) Department of Pediatric Surgery, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania 3) Department of Thoracic Surgery, “Marius Nasta” Institute of Pneumophthisiology, Bucharest, Romania 4) Department of Pediatric Oncology, “Maria Skłodowska Curie” Emergency Clinical Hospital for Children, Bucharest, Romania 5) Department of Pathology, Medcenter Laboratory, Bucharest, Romania 6) Department of Anatomy, Faculty of Nursing Tirgu Jiu, “Titu Maiorescu” University, Bucharest, Romania Abstract T-cell lymphoblastic lymphoma is an aggressive malignancy that represents 85% of all lymphoblastic lymphomas. It usually occurs in late childhood, adolescence and young adulthood with a 2:1 male preponderance and it presents with pleural effusion and respiratory symptoms and in rare cases vena cava syndrome can be encountered. We present the case of a 13-year-old patient who was referred to our clinic from a local hospital where he was diagnosed with a mediastinal tumor. The patient presented with thoracic pain, fever, coughing and fatigability for a month prior to admission, after having underwent surgery for abdominal pain (appendectomy). On admission to our hospital, a thoracic computed tomography (CT) scan was performed and showed the presence of an anterior mediastinal mass measuring 109/76/140 mm, well defined, which came in close contact with the superior vena cava, the ascending aorta and the pulmonary artery, right pleural effusion and a collapsed lung on the right side. The decision was taken to perform a tumor biopsy and a right pleural drain was placed. The patient’s post-operative evolution was favorable with the remission of the respiratory symptoms. The histopathological result showed the presence of T-cell lymphoblastic lymphoma and the patient was then transferred to the oncology ward where he underwent chemotherapeutic treatment, with a favorable outcome. T-cell lymphoblastic lymphoma is an aggressive type of lymphoma and it is usually hard to diagnose considering the fact that the symptoms are often vague. It is essential to establish the diagnosis without delay and start appropriate chemotherapeutic treatment. Keywords: lymphoblastic lymphoma, pleural effusion, mediastinal biopsy.  Introduction T-cell lymphoblastic lymphoma (T-LBL) is an aggressive malignancy and represents 85–90% of all lymphoblastic lymphomas [1–3]. It usually occurs in late childhood [1], adolescence and young adulthood with a 2:1 male pre- ponderance T-LBL frequently presents as a mediastinal mass, with secondary localizations such as skin, liver, spleen, central nervous system or testis, although these sites without mediastinal involvement is rare [2, 4]. While pleural effusion and mediastinal adenopathies are common signs of T-LBL, establishing an accurate diagnosis is often challenging. Treatment for T-LBL consists of chemo- therapy and is usually divided into three phases: induction, consolidation and maintenance [2]. In children, the five- year survival rate with treatment is between 80–90% [3]. We present a case of T-LBL in a patient with a large mediastinal tumor, in whom clinical symptoms were unsophisticated for a long period of time.  Case report We present the case of a 13-year-old patient who was referred to our clinic from a local hospital where he was diagnosed with a mediastinal tumor. A month prior to admission the patient presented to a local hospital with fever and abdominal pain and he was diagnosed with acute appendicitis and underwent an emergency appendectomy. His post-operative evolution was favorable and three days after surgery he was discharged. A week later, the patient presented to the emergency room for thoracic pain, fever, coughing and fatigability and was admitted to hospital with the suspicion of pneumonia; a thoracic X-ray and a computed tomography (CT) scan were performed and showed pleural effusion and the presence of a mediastinal mass (Figures 1 and 2). The patient was then referred to our clinic. On admission, the patient presented with an altered general state, fever (38.1 0 C), 93% O 2 saturation, 40 respirations per minute, cough and an abolished vesicular murmur in the right hemithorax. A thoracic CT scan was performed and showed the presence of a well-defined, anterior mediastinal mass measuring 109/76/140 mm, which came in close contact with the superior vena cava, the ascending aorta and the pulmonary artery, massive right pleural effusion and a collapsed lung on the right side. An echo- cardiography was also performed and revealed pericardial effusion. Under general anesthesia, an evacuatory pleural drainage R J M E Romanian Journal of Morphology & Embryology http://www.rjme.ro/