High-Grade Round Cell Neoplasm Presenting as an Anterior Mediastinal Mass With Features of Desmoplastic Round Cell Tumour

Sep 28, 2026

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Desmoplastic small round cell tumours (DSRCT) are highly aggressive neoplasms typically affecting adolescent and young adult males. A rare high-grade round cell tumour with DSRCT-like features is described in a young female who initially presented with anaphylactic reactions to blueberries, later found to have an anterior mediastinal mass. Contrast-enhanced CT showed a large round-cell tumour encasing mediastinal structures, confirmed by histopathology. Combined chemoradiotherapy was planned, but the patient left against medical advice. The report emphasizes early recognition and multidisciplinary management.

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Review began 11/11/2025 Review ended 11/26/2025 Published 12/02/2025 © Copyright 2025 Thomas. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited. DOI: 10.7759/cureus.98309 Open Access Case Report High-Grade Round Cell Neoplasm Presenting asan Anterior Mediastinal Mass With Features of Desmoplastic Round Cell Tumour Maridas T. Thomas 1 1. General Internal Medicine, University Hospitals of Leicester, Leicester, GBR Corresponding author: Maridas T. Thomas, [maridastomt@gmail.com](maridastomt@gmail.com) Abstract Desmoplastic small round cell tumours (DSRCT) are highly aggressive neoplasms typically affecting adolescent and young adult males. We present a rare case of high-grade round cell tumour with features of DSRCT in a young female who initially presented with anaphylactic reactions to blueberries, which, on further evaluation, revealed an anterior mediastinal mass. Contrast-enhanced CT (CECT) of the thorax demonstrated a large, round cell tumour encasing multiple mediastinal structures, later confirmed by histopathology. The patient was offered combined chemotherapy and radiotherapy; however, she opted to leave against medical advice. This case highlights an unusual presentation of DSRCT and underscores the importance of early recognition and multidisciplinary management. Categories: Oncology Keywords: anterior mediastinal mass, chemotherapy, desmoplastic small round blue cell tumours, rare tumour, surgery, young female Introduction Round cell tumours are aggressive neoplasms requiring early diagnosis and prompt treatment for improved survival. Round cell tumours encompass a wide variety of tumours which show features of round to medium-sized cells with scanty cytoplasm and hyperchromatic nuclei. The various types of tumours can be distinguished by the variety of clinical presentation, tumour markers and the radiological features. They exhibit a strong male predominance. Desmoplastic small round cell tumour (DSRCT), a subtype of this group, is characterized by nests of small, round tumour cells surrounded by desmoplastic stroma. It most commonly occurs in the abdomen, with thoracic presentations being exceedingly rare. Here we describe a rare case of small round cell tumour which presented as an anterior mediastinal mass and shows clinical and histopathological features of a round cell tumour and is mostly suggestive of a DSRCT, though confirmation without doubt would require an immunohistochemistry showing expression of epithelial, mesenchymal and neural markers. Case Presentation A 20-year-old female presented with a two-month history of cough, intermittent facial swelling, hoarseness of voice, and wheezing. Initially, these symptoms were attributed to an allergic reaction to blueberries, which she frequently consumed. During two prior hospital visits, she was diagnosed with anaphylaxis and treated successfully with adrenaline and corticosteroids. Although her symptoms improved temporarily upon discontinuation of blueberries, she noted progressive cough, distension of neck veins, and worsening hoarseness, all of which were suggestive of a superior vena cava syndrome. On admission, a chest X-ray revealed an anterior mediastinal mass (Figure 1) . Laboratory evaluation showed elevated lactate dehydrogenase (LDH) levels, raising suspicion for lymphoma. Other tumour markers like Alpha Feto Protein and Beta hCG were within normal levels. Contrast-enhanced computed tomography (CECT) of the thorax revealed an ill-defined, heterogeneously enhancing mass measuring 83 × 108 × 103 mm in the prevascular region of the anterior mediastinum, predominantly on the right side (Figure 2) . The lesion abutted the right atrium with loss of fat planes posteriorly and contained necrotic and cystic areas. It encased t

FAQs

What initial symptoms led to the discovery of the anterior mediastinal mass?

The patient presented with anaphylactic reactions to blueberries along with cough, intermittent facial swelling, hoarseness of voice, and wheezing. Further evaluation revealed progressive signs suggestive of superior vena cava syndrome and an anterior mediastinal mass.

How was the mass evaluated and what did imaging show?

Contrast-enhanced CT of the thorax demonstrated an ill-defined, heterogeneously enhancing anterior mediastinal mass with necrotic and cystic areas. It encased major structures including the superior vena cava and branches of the aortic arch, with partial encasement of the trachea and oesophagus.

What treatment plan was proposed and why was surgery not performed?

Given the tumour’s high-grade nature and involvement of major mediastinal vessels, surgical resection was deemed infeasible. The case was reviewed by a multidisciplinary tumour board, and combined chemoradiotherapy was planned, but the patient left the hospital against medical advice.

Sep 28, 2026

Uploaded by jayni