A 9 year old boy presents with mild facial swelling for 2 weeks, in association with a nonproductive cough. There was no history of fever, headache, rhinorrhea, or pruritis. His mother had taken him to a primary care practitioner 1 week ago, who had subsequently prescribed antihistamines. These had not relieved his symptoms. His mother mentions that he has also been somewhat tired and lethargic for the last couple of months. His birth, medical, surgical and family histories are completely unremarkable. A full blood count, urinalysis, renal functions, and serum electrolytes are all found to be normal
There is a large mass in the superior mediastinum, causing mediastinal deviation towards the right.
MRI reveals the presence of a 6.2 x 5.3 x 5.1 cm homogenous soft-tissue mass in the superior mediastinum compressing the superior vena cava (SVC). The mass is hypointense in T1 images and slightly hyperintense in T2 weighted images. MRA shows partial thrombosis of the SVC.
Fine needle aspiration cytology reveals the presence of plasma cells, eosinophils, and large atypical cells, including typical Reed-Sternberg cells.
You realize that bronchoscopy is probably not indicated in this patient.