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In this report, we discussed a case of a 35 year-old man who presented with chronic cough, dyspnea, pleuritic chest pain and weight loss for 1 month. On chest X-ray, an anterior mediastinal mass was detected. To obtain further information, chest computed tomography (CT) with contrast enhancement was performed, revealing an anterior mediastinal mass with central low attenuation. Percutaneous needle biopsy was performed. The diagnosis on his first hospital admission was B cell lymphoma. Finally, pathologic diagnosis was pleomorphic rhabdomyosarcoma. The rarity of this disease make mediastinal rhabdomyosarcoma patients among the most difficult todiagnose. Rhabdomyosarcomas manifest as masses that are often large and of variable attenuation due to necrosis and cystic components. The prognosis for patients with mediastinal rhabdomyosarcoma is poor. Possible causes of this are the difficulty in obtaining early detection and the chemo-resistance of these tumors, and metastatic potential.
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