Primary mediastinal sarcoma presenting with supraclavicular and chest wall metastasis

Primary mediastinal sarcomas (PMS) are uncommon cancerous tumors that typically affect young adults. They are mesenchymal tumors, generally large, involving adjacent vital structures, which complicates diagnosis and treatment. We report a 35-year-old male with a 30-day history of progressive cough, dyspnea, and significant weight loss. Clinical examination revealed painless, firm swellings in the right supraclavicular and parasternal regions. Imaging showed a large anterior mediastinal mass, cervical lymphadenopathy, and chest wall invasion. Laboratory findings included leukocytosis. Core needle biopsy and immunohistochemistry (IHC) confirmed a diagnosis of PMS of mesenchymal origin. This case underscores the challenges in diagnosing and managing mediastinal sarcomas, emphasizing the importance of imaging and IHC. Due to anatomical limitations, complete surgical resection is often difficult, necessitating a multidisciplinary approach.