Xuan, 22, experienced persistent dry cough and chest tightness, leading to a diagnosis of a massive 25 cm mediastinal tumor. The tumor, described as the size of a grapefruit, had encircled her heart, lungs, and major blood vessels. Associate Professor, Doctor Vu Huu Vinh, Director of the Center for Thoracic and Vascular Surgery at Tam Anh General Hospital, Ho Chi Minh City, stated that Xuan had undergone needle biopsies three times at a previous hospital without a definitive diagnosis, while the lesion continued to grow.

The tumor's advanced stage presented significant risks. It had invaded the chest wall and was surrounded by a dense network of blood vessels. Further needle biopsies risked rupturing these vessels, potentially leading to massive hemorrhage and life-threatening complications. Following a consultation, the medical team at Tam Anh General Hospital decided on an endoscopic surgical biopsy. This approach was chosen to safely access the tumor, accurately determine its nature, and develop an optimal treatment protocol, while minimizing damage to vital surrounding structures such as the heart, lungs, and superior vena cava.

X-ray image shows the tumor (circled in red) invading the young woman's entire chest. *Photo: Tam Anh General Hospital*

During the procedure, doctors made a small incision in the front of Xuan's chest, next to the sternum. A specialized instrument equipped with a camera was then inserted to access the tumor. Magnified images guided the team in precisely dissecting the biopsy site, carefully avoiding rupture of vital blood vessels and maximally preserving organ function.

Immediate frozen section analysis of the biopsy sample indicated lymphoma. Subsequent histopathology confirmed the diagnosis as non-Hodgkin lymphoma, a type of lymphatic cancer. Non-Hodgkin lymphoma accounts for 90% of all lymphoma cases, with Hodgkin lymphoma being the other main type. Associate Professor Vinh explained that lymphoma generally responds well to chemotherapy. Consequently, Xuan received chemotherapy to enable the tumor to regress spontaneously, thereby avoiding the risks and high costs associated with major surgery.

Associate Professor Vinh (center) performing a biopsy for the patient. *Photo: Tam Anh General Hospital*

Lymphoma can affect individuals of various ages, including young people like Xuan. The primary cause of the disease is gene mutations. Other factors that pose a potential risk include: immune deficiency, chronic viral infections such as Epstein-Barr virus, and exposure to toxic chemicals.

Individuals should seek early medical attention if they experience symptoms such as: painless swollen lymph nodes in the neck, armpit, or groin; persistent cough; shortness of breath; chest tightness; unexplained facial and neck swelling; or night sweats. Prompt diagnosis and timely treatment are crucial.

Bao Anh

*Patient's name has been changed

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