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Existing pipelines often rely on predefined organ phrases or brittle rule-based inference-time extraction, which limits their scalability to novel anatomical structures and makes them sensitive to linguistic variations. To address this, we propose ReportMedSAM, a report-driven framework that replaces discrete extraction with a learnable concept bank. By leveraging a frozen medical vision-language encoder (BiomedCLIP), we align organ-level concept embeddings with large-scale clinical corpora through contrastive learning, establishing mutually orthogonal semantic anchors. Our approach explicitly mitigates organ-level semantic collapse and ensures high robustness against diverse clinical synonyms (e.g., \"renal\" vs. \"kidney\" ). 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