Primary Hodgkin's disease of the lung

A Persistent Pulmonary Puzzle: Diagnosing Hodgkin Lymphoma in a Young Female With Chronic Respiratory Symptoms

Hodgkin lymphoma (HL), a lymphoid neoplasm characterized by the presence of Reed-Sternberg cells, often presents with painless lymphadenopathy and systemic symptoms. This case report details the diagnostic journey of a 27-year-old non-smoker female with chronic respiratory symptoms, including persistent cough, hemoptysis, and weight loss over two years. Despite multiple treatments for presumed infections and extensive diagnostic procedures, the correct diagnosis of HL was delayed due to atypical pulmonary manifestations, notably necrotizing pneumonia and multiple cavitary lung lesions. Ultimately, histopathology from a third bronchoscopy confirmed HL, highlighting the complexity of diagnosing HL with unusual presentations. Patients with cavitary lesions have a poor prognosis compared to others with typical pulmonary involvement, as cavitation in HL is likely caused by central ischemia necrosis due to the tumor's rapid growth. This case can be considered a primary pulmonary HL, a rare and hard-to-treat presentation since it does not respond well to radiotherapy. It emphasizes the challenge in diagnosing HL when it presents atypically, making it crucial to consider HL in differential diagnoses to avoid delayed diagnosis and improve patient outcomes.

Diagnostic utility of transbronchial biopsy for Hodgkin's lymphoma: A case study

Lung lesions of Hodgkin's lymphoma (HL) are rare and difficult to diagnose by nonsurgical biopsy. We herein present the case of a 72-year-old Japanese male who presented with accumulation of lung infiltrates and masses bilaterally on the lungs for 3 years. Although transbronchial lung biopsy (TBB) and computed tomography-guided biopsy were conducted several times, his diagnosis remained inconclusive. On further deterioration of lung lesions, the patient was transferred to our hospital. Positron emission tomography revealed increased accumulation in the bilateral lungs and right supraclavicular lymph nodes. Surgical biopsy of the lymph node was performed. He was finally diagnosed with HL and underwent chemotherapy with doxorubicin, vinblastine, dacarbazine, and brentuximab vedotin. After chemotherapy, the lung lesion showed significant regression. A literature review indicated that the diagnostic success rate of TBB was low (18.5%) in cases of lung lesions in HL.

Primary Pulmonary Hodgkin's Lymphoma: A Rare Etiology of a Cavitary Lung Mass

Primary pulmonary Hodgkin's lymphoma (PPHL) is an uncommon disease. This entity is different from Hodgkin's lymphoma with parenchymal or nodal lung involvement. In this report, we highlight the case of a young female presenting with a six-month history of a productive cough and constitutional B symptoms. Imaging showed cavitary lesions in the right-upper and right-middle lobes. The initial comprehensive infectious workup was negative. Histopathology and immunochemistry confirmed the diagnosis of PPHL. PPHL is an uncommon etiology of cavitary lung lesions. Despite its diagnostic difficulties, awareness of such a disease is crucial, given its high rate of response to treatment, especially in the young population.

Primary Pulmonary Hodgkin Lymphoma

Primary pulmonary Hodgkin lymphoma (PPHL) is a rare disease. Herein, we report a case of PPHL with diagnostic concerns encountered during initial evaluation which is of paramount importance to keep the differential diagnosis in cases with high index of suspicion for this rare entity.

Primary pulmonary Hodgkin's lymphoma and a review of the literature since 2006

A 28-year-old woman of Laotian origin presented with dry cough, fevers, night sweats and weight loss over the preceding 6 weeks. Radiological investigations revealed large complex cavitary lesions in the middle and lower lobes of the right lung, with no mediastinal lymph node enlargement. Bronchoscopic investigations did not yield a diagnosis. CT-guided fine-needle aspiration raised the possibility of Langerhans cell histiocytosis. Open lung biopsy initially supported this, but eventually a microscopic and immunohistochemical diagnosis of Hodgkin's lymphoma was made. The final diagnosis was primary pulmonary Hodgkin's lymphoma. We present a new case as well as a literature review of reported cases published since 2006.

Primary pulmonary hodgkin lymphoma simulating a mediastinal tumour: an uncommon occurrence

The case of a patient with primary pulmonary Hodgkin Lymphoma simulating a mediastinal tumour is reported for its rarity and the diagnostic concerns encountered by us.

Primary pulmonary classical hodgkin lymphoma with two recurrences in the mediastinum : a case report

We report a case of primary pulmonary classical Hodgkin lymphoma (CHL) in a 58-year-old woman. Twelve years ago, the patient complained of slight fever and weight loss. A mass of about 5 cm in diameter was seen in the right lung on radiography and computed tomography (CT). Right total pneumonectomy and resection of mediastinal lymph nodes were performed. A pathological examination led to a strong suspicion of Hodgkin disease (HD) (now referred to as CHL), but a definite diagnosis could not be made at the time. Six years later, a chest CT showed a tumor around the ascending aorta, which was treated successfully by radiation therapy. Six years later, the chest CT revealed a tumor in the anterior mediastinum. CHL was diagnosed based on an immunohistochemical re-examination of lung specimens resected 12 years earlier and CT-guided fine needle tumor biopsy specimens of the second recurrent tumor in the anterior mediastinum were compatible with the recurrence of CHL. Therefore, we diagnosed this case as primary pulmonary CHL that later relapsed in the mediastinum. The tumor size was reduced by radiation therapy and the patient is currently under observation as an outpatient.

Contribution of the 2-[18F]-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography to the diagnosis of primary osseous Hodgkin lymphoma

Hodgkin lymphoma typically presents as a nodal lesion and infrequently involves extra nodal sites. Although cases of primary extra-nodal Hodgkin lymphoma have been reported previously, the reality of the primitive nature of the disease was difficult to authenticate with traditional high resolution imaging techniques, such as computed tomography or magnetic resonance imaging, because they cannot evaluate the spread of the disease throughout the whole body. We report here a case of primary osseous Hodgkin lymphoma, regarded as stage I extranodal IE thanks to the important contribution of a new imaging technique, the 2-[18F]-fluoro-2-deoxy-d-glucose positron emission tomography/ computed tomography (18F-FDG-PET/CT). PET enables systemic Hodgkin lymphoma with secondary bone invasion to be distinguished from primitive osseous Hodgkin lymphoma. This technique is highly specific in demonstrating the isolated osseous localisation of the tumour and should be recommended in all patients with putative osseous lymphoma.

Pulmonary lymphoma identified as a result of low-dose CT screening for lung cancer

PURPOSE

To describe the frequency and findings of pulmonary lymphoma in asymptomatic people undergoing computed tomographic (CT) screening for lung cancer.

METHODS

All lymphoma diagnoses resulting from CT screening of 31 567 at-risk subjects (median age, 61 years) were identified, and the CT images were reviewed to document the lesions as to number, location, density, shape, and margin. The presence of lymphadenopathy and pleural effusion was also documented.

RESULTS

Five patients with pulmonary lymphoma were identified. The lymphoma was a B-cell lymphoma in three, Hodgkin's lymphoma in one, and malignant lymphoma in one; it was primary in four and secondary in one. One patient had two lesions; the other four patients each had one lesion. Four of the six lesions were a mass, and two were a nodule. Four of the lesions had irregular margins. Air bronchograms were seen in three. Growth assessment was useful in leading to decisions for biopsy.

CONCLUSION

In a context of CT screening to detect lung cancer in asymptomatic volunteers, the diagnosis of pulmonary lymphoma was rare but, nevertheless, occurred in five (.016%) of 31 567 volunteers.

Pulmonary lymphomatoid granulomatosis in a dog: evidence of immunophenotypic diversity and relationship to human pulmonary lymphomatoid granulomatosis and pulmonary Hodgkin's disease

We describe a 10-month-old, intact female American Cocker Spaniel with pulmonary lymphomatoid granulomatosis (PLG). On clinical examination, this dog presented with nonproductive dry cough, serous nasal discharge, dyspnea, and lack of appetite. Radiography showed a consolidated lesion in the left cranial lung lobe. Histopathologic examination showed a mixed population of atypical lymphoid cells that had infiltrated into the pulmonary blood vessels angiocentrically. The lymphocytes were CD3 positive, consistent with a pan-T-cell phenotype. The lymphoid cells in the lesion were also positive for CD20cy and CD79a, indicative of the presence of B cells. We also observed large Reed-Sternberg-like cells that were positive for CD15 and CD30, similar to observations in human pulmonary Hodgkin's disease (PHD). In conclusion, canine PLG in this Cocker Spaniel was associated with B and T cells, which is first identified in a case of canine PLG. It was histopathologically similar to human lymphomatoid granulomatosis and immunophenotypically similar to human PHD.

Hodgkin lymphoma presenting with exclusive or preponderant pulmonary involvement: a clinicopathologic study of 5 new cases

A review of the pathological features of Hodgkin lymphoma manifesting with exclusive or preponderant lung involvement is given for 5 patients. Three patients were men and 2 were women, with an age range 17 to 48 years (median, 42 years). They presented with nonspecific symptoms including dry cough, fever, or chest pain. Initial clinical assessment suggested a lung tumor. Pathological evaluation was carried out on lung biopsy, wedge resection, lobectomy, or pneumonectomy specimens. All the cases showed diagnostic Reed Sternberg cells within the proper background. Immunopositivity for CD15 and CD30 was documented as well. Nodular sclerosing and mixed cellularity were the documented subtypes. Additional histologic features were a pronounced nodular growth pattern with or without necrosis, a diffuse hypersensitivity pneumonia-like picture, or acute pneumonia-like changes. Our study confirms that the recognition of Hodgkin lymphoma in lung, although based on well-established morphologic criteria, may represent a source of interpretative problems because of the unusual clinical presentation as well as the peculiar histologic changes induced within the pulmonary microenvironment.

[Pancoast syndrome and endobronchial tumor infiltration as the first manifestation of Hodgkin lymphoma]

The most common cause of Pancoast syndrome is bronchogenic carcinoma. Other less common causes are solid tumor metastases, other chest tumors, infections, and hematologic neoplasms. Pancoast syndrome due to lymphoma is very rare, and cases described in the literature are essentially associated with non-Hodgkin lymphomas. In a review of the literature we found a single case of Pancoast syndrome secondary to a Hodgkin lymphoma; however, the syndrome manifested during recurrence of disease in that patient. We report a case of nodular sclerosis Hodgkin lymphoma which first manifested clinically as Pancoast syndrome and which was initially diagnosed by bronchial biopsy.

Lymphoma at uncommon sites

Lymphoma can often present in unusual situations. This article provides a comprehensive review of the literature in which both non-Hodgkin's lymphoma and Hodgkin's disease are discussed.