{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T05:04:19Z","timestamp":1789535059145,"version":"build-2803163510"},"reference-count":10,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Mediastinal gray zone lymphoma (MGZL) is a rare and biologically complex lymphoma with overlapping features of primary mediastinal B-cell lymphoma and classical Hodgkin lymphoma. Bulky mediastinal disease frequently complicates central venous access, particularly in the presence of superior vena cava (SVC) syndrome. Reports addressing optimal vascular access strategies in this setting remain limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>A 41-year-old man presented with newly diagnosed MGZL and a large mediastinal mass causing clinically significant SVC obstruction. The patient required urgent initiation of intensive systemic treatment; however, standard central venous access was contraindicated due to altered thoracic venous anatomy. A tunneled femoral catheter was therefore inserted to allow treatment initiation with rituximab plus dose-adjusted etoposide, doxorubicin, vincristine, cyclophosphamide, and prednisone (R-DA-EPOCH). The clinical course was complicated by catheter-related bloodstream infections caused by multidrug-resistant pathogens, septic shock, and pulmonary embolism, necessitating intensive care management. Following partial tumor response and anatomical decompression, duplex ultrasound\u2013guided evaluation enabled successful implantation of a chest port via the left internal jugular vein, during which a duplicated superior vena cava was identified. Subsequent catheter-tip thrombosis was managed with low-molecular-weight heparin. Through coordinated multidisciplinary care, full-intensity R-DA-EPOCH was completed up to dose level 4, resulting in complete metabolic remission.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case highlights the critical importance of individualized venous access strategies in patients with mediastinal lymphoma complicated by SVC syndrome. Imaging-guided vascular assessment, multidisciplinary coordination, and adherence to international and national guidelines can enable safe delivery of curative-intent intensive chemotherapy, even in the setting of severe anatomical distortion and life-threatening complications. The case offers a visually documented, practical framework for managing venous access in complex anatomical conditions associated with superior vena cava syndrome.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1811919","type":"journal-article","created":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T04:30:37Z","timestamp":1789533037000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Complex venous access in superior vena cava syndrome secondary to gray zone lymphoma, case report"],"prefix":"10.3389","volume":"16","author":[{"given":"Martin","family":"Razus","sequence":"first","affiliation":[{"name":"Institute of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine, Comenius University","place":["Bratislava, Slovakia"]},{"name":"Department of Oncohematology, Faculty of Medicine, Comenius University","place":["Bratislava, Slovakia"]},{"name":"National Cancer Institute","place":["Bratislava, Slovakia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maros","family":"Kunderlik","sequence":"additional","affiliation":[{"name":"I. Department of Oncology, Faculty of Medicine, Comenius University","place":["Bratislava, Slovakia"]},{"name":"St. Elisabeth Cancer Institute","place":["Bratislava, Slovakia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michal","family":"Marko","sequence":"additional","affiliation":[{"name":"National Cancer Institute","place":["Bratislava, Slovakia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanda","family":"Repiska","sequence":"additional","affiliation":[{"name":"Institute of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine, Comenius University","place":["Bratislava, Slovakia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pavol","family":"Povinec","sequence":"additional","affiliation":[{"name":"BIONT","place":["Bratislava, Slovakia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bela","family":"Mrinakova","sequence":"additional","affiliation":[{"name":"I. Department of Oncology, Faculty of Medicine, Comenius University","place":["Bratislava, Slovakia"]},{"name":"St. Elisabeth Cancer Institute","place":["Bratislava, Slovakia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,16]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdv296","article-title":"Central venous access in oncology","volume":"26","year":"2015","journal-title":"Ann Oncol"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2025.1679363","article-title":"Safety of totally implantable venous access devices and peripherally inserted central catheters in hematological Malignancies patients: a meta-analysis","volume":"15","author":"Gu","year":"2025","journal-title":"Front Oncol"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.3389\/frhem.2023.1171991","article-title":"Peripherally inserted central catheter insertion and management in Hodgkin and non-Hodgkin lymphomas: a 13-year monocentric experience","volume":"2","author":"Derudas","year":"2023","journal-title":"Front Hematol"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cir257","article-title":"Guidelines for the prevention of intravascular catheter-related infections","volume":"52","author":"O\u2019Grady","year":"2011","journal-title":"Clin Infect Dis"},{"key":"B5","article-title":"Doporu\u010den\u00ed pro zav\u00e1d\u011bn\u00ed a p\u00e9\u010di o porty a permanentn\u00ed kat\u00e9try","year":""},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.21203\/rs.3.rs-5778445\/v1","article-title":"Assessment of long-term complications in adult oncology patients with superior vena cava syndrome receiving tunnelled femoral catheters: a prospective cross-sectional study","author":"Wu","year":"2025","journal-title":"Research Square"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1056\/nejmoa025313","article-title":"Low-molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer","volume":"349","author":"Lee","year":"2003","journal-title":"N Engl J Med"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1111\/jth.15358","article-title":"Use of direct oral anticoagulants in patients with obesity for treatment and prevention of venous thromboembolism: Updated communication from the ISTH SSC Subcommittee on Control of Anticoagulation","volume":"19","author":"Martin","year":"2021","journal-title":"J Thromb Haemost"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.182.5.1821139","article-title":"Venous anomalies of the thorax","volume":"182","author":"Demos","year":"2004","journal-title":"AJR Am J Roentgenol"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2014-03-564906","article-title":"Phase II study of dose-adjusted EPOCH-R in untreated mediastinal gray zone lymphoma","volume":"124","author":"Wilson","year":"2014","journal-title":"Blood"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1811919\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T04:30:47Z","timestamp":1789533047000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1811919\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,16]]},"references-count":10,"alternative-id":["10.3389\/fonc.2026.1811919"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2026.1811919","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,16]]},"article-number":"1811919"}}