Mediastinal Mass and Pleural Effusion: different clinical presentations of lymphoma in pediatric age

Background: Mediastinal masses and pleural effusions may have different etiologies, from infectious to malignant and autoimmune diseases, originating from the mediastinum or nearby structures. Several signs and symptoms, such as persistent anemia, dyspnea, chronic itching, and mantle oedema, may raise suspicion of a malignant disease. Specifically, lymphomas may be a common cause of both mediastinal masses and pleural effusions. Case presentation: We report the cases of two children, aged 9 and 13, who were admitted to the Pediatric Unit of AOU “Gaetano Martino” in Messina with pleural effusion and superior vena cava syndrome, respectively. Both had a previous history of SARS-CoV-2 infection a few months prior. Clinical, laboratory and radiological findings suggested the presence of a mediastinal mass, compatible with lymphoma. Conclusions: Tumors are a rare clinical entity in pediatric age. These cases highlight the importance of an accurate diagnostic workup and the critical role of identifying red flags. Nowadays, precision medicine plays a fundamental role as it uses the knowledge of genetic and biochemical profiles of a disease to tailor diagnosis and therapy for pediatric patients with tumors.