A patient with acute leukaemia presenting with superior vena cava syndrome due to a large mediastinal mass is reported. The presence of blast cells with Auer rods in peripheral blood and bone marrow allowed the diagnosis of acute myeloblastic leukaemia. Following intensive chemotherapy the patient achieved a complete remission, with disappearance of the signs of venous obstruction and normalization of the chest roentgenogram. Although no histopathological documentation of the mediastinal tumor was available, its myeloblastic origin was assumed in view of the clinical course.

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