ACTA ENDOCRINOLOGICA (BUC)

Chest pain in children is a common referral for emergency examination, although it is believed that the underlying condition is not a serious event. The authors present the case of a 17 years old male with complaints of chest pain with a very recent onset, constant, experienced after physical effort. All medical history and physical examination findings were normal, the poster-anterior chest X-ray revealed a heterogenous opacity in the middle third of the right hemithorax confirmed on computerized tomography as a large solid anterior mediastinal mass with a diameter of 7.5/10.3 cm. By thorax surgery the mass was identified in the anterior and superior mediastinum and total resection was achieved for the tumor mass and thymus. Pathology examination showed poor small and medium epithelial cells proliferation and the tumor was classified as thymoma type 1B. Mediastinum is a rare location of space occupying processes in children. Also, there is a high rate of asymptomatic lesions in this area, considering that half of them are incidentally discovered for various chest X ray examinations. Many causes of chest pain in children are benign; nonetheless, some serious events do exist sometimes and pediatricians must pay attention to identify and manage those cases.

An increased risk of non-Hodgkin?s lymphoma was found for a personal history of autoimmune conditions: rheumatoid arthritis, systemic lupus erythematosus, celiac disease, autoimmune hemolytic anemia, Crohn?s disease, psoriasis, sarcoidosis and thyroiditis. The associations may not be general but rather for specific non-Hodgkin?s lymphoma subtypes. These non-Hodgkin?s lymphoma subtypes develop during postantigen exposure stages of lymphocyte differentiation, consistent with a role of antigenic drive in autoimmunity-related lymphomagenesis. We present the case of a 30 years old mane, with simultaneous diagnosis of Graves? disease and a huge anterior mediastinal mass which was actually the mediastinal involvement of a diffuse large B-cell lymphoma stage III. The patient had also hypercalcemia, remitted after two courses of chemotherapy. The possible relationship between the two diseases and the role of parathyroid hormone related peptide PTHrP in paraneoplastic syndrome is discussed.