In this report, we present the case of a 73-year-old male who was seen at Clinic with a 4-month history of persistent cough. The gentleman was an ex-smoker with a 40-pack-year history and known case of non-Hodgkins lymphoma in remission for 25 years. Initial examination revealed decreased air entry on the right base and a prominent chest wall mass at the mid sternum. This was boggy and non-tender on palpation and associated with overlying violaceous skin changes and 2 nodules. CT thorax demonstrated a large mass lesion involving the anterior chest wall measuring 16.5 cm × 8.0 cm with extensive destruction of the sternum with extension into anterior mediastinum invading left brachycephalic vein. PET CT confirmed lesion was FDG avid and US guided biopsy confirmed High-grade B-cell lymphoma with a germinal center phenotype. The patient was treated with target chemotherapy with notable remission.
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