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An Unusual Presentation of Hodgkin's Lymphoma: Endobronchial and Pleural Involvement FREE TO VIEW

Justin Reis, MD; Michael Tripp, MD
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Naval Medical Center San Diego, San Diego, CA

Chest. 2014;146(4_MeetingAbstracts):611A. doi:10.1378/chest.1994948
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SESSION TITLE: Cancer Case Report Posters I

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PM

INTRODUCTION: Hodgkin’s Lymphoma (HL) is a relatively uncommon cause of lymphoma in the adult population accounting for approximately 10% of all cases of lymphoma. The classic presentation typically involves asymptomatic lymphadenopathy or a mediastinal mass incidentally detected on chest radiograph. Extranodal involvement at initial presentation within the lung parenchyma is relatively rare in HL and accounts for approximately 6-12% of cases. Even less common is disease affecting the pleura or endobronchial involvement. We present a case of Hodgkin's Lymphoma with both pleural and endobronchial involvement at initial presentation.

CASE PRESENTATION: A previously healthy 59-year old male presented with subacute development of a nonproductive cough initially attributed to an upper respiratory infection. A chest radiograph showed a dense, right mid-lung field opacity. Computed tomography (CT) of the chest confirmed the presence of a large pleural-based mass and an infiltrative process in the mediastinum. Rightward tracheal deviation was also noted, but no bronchial compression or endobronchial lesions were identified on CT. Subsequent positron emission tomography revealed intense fluorodeoxyglucose uptake within the pleural-based mass and mediastinum. A bronchoscopy was performed, and numerous endobronchial plaques were identified within bilateral airways. Endobronchial ultrasound (EBUS) guided trans-bronchial needle aspiration biopsies of the mediastinal mass, in addition to biopsies of the endobronchial plaques demonstrated histologic and immunohistochemical staining properties consistent with classic Hodgkin’s lymphoma.

DISCUSSION: Although pulmonary involvement in HL can be seen in 15% to 40% of patients at some time during the course of their disease, the true incidence of endobronchial involvement at initial presentation remains unknown, often due to the lack of bronchoscopic evaluation in patients without respiratory symptoms. Very few case series involving endobronchial HL describe pleural effusions, and none reported solid pleural involvement.

CONCLUSIONS: Endobronchial presentation of Hodgkin’s lymphoma is rare, with less than 30 cases reported in the literature. Pleural involvement is uncommon as well, but to our knowledge there are no reported cases of patients presenting with both endobronchial and pleural-based HL making this case unique.

Reference #1: Kiani B, Magro CM, Ross P. Endobronchial presentation of Hodgkin lymphoma: a review of the literature. The Annals of Thoracic Surgery. 2003 Sep; 76(3):967-72.

DISCLOSURE: The following authors have nothing to disclose: Justin Reis, Michael Tripp

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    Print ISSN: 0012-3692
    Online ISSN: 1931-3543