Lung Cancer |

Primary Pulmonary Hodgkin's Lymphoma: A Rare Etiology of a Cavitary Lung Lesion FREE TO VIEW

Halim El-Hage, MD; Mohamad Yasmin, MD; Ambreen Khalil, MD
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Staten Island University Hospital, Long Island City, NY

Chest. 2015;148(4_MeetingAbstracts):583A. doi:10.1378/chest.2215436
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SESSION TITLE: Lung Cancer Student/Resident Case Report Posters

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM

INTRODUCTION: Pulmonary involvement in Hodgkin’s lymphoma is common. In contrast primary pulmonary Hodgkin’s lymphoma (PPHL) is a very rare presentation of Hodgkin’s disease. In a young patient, PPHL usually mimics an infectious process posing a diagnostic dilemma. PPHL is considered when histological features of Hodgkin’s lymphoma are present in the lung but nodal and extra pulmonary disease is excluded. We herein present a case of PPHL in a young patient.

CASE PRESENTATION: A 27-year-old female, who was an active smoker, with no past medical history presented to the emergency department complaining of productive cough and night sweats of six months duration. She had a fever of 101 °F, decreased breath sound on the right side of the chest and leukocytosis. Chest x-ray showed two multi-loculated cavitary lesions involving the upper and middle lobes of the right lung. A chest computed tomography (CT) scan identified a heterogeneous cavitary mass in the middle and upper lobes of the right lung. The patient was started on antibiotic therapy for community-acquired pneumonia and isolated for suspected mycobacterial tuberculosis. Initial investigative work-up, which included sputum and blood cultures, acid fast staining, cryptococcal antigen, and HIV serology, was unremarkable. Bronchoscopy with ultrasound-guided biopsy was non-diagnostic. CT-guided aspiration biopsy identified extensive necrosis with atypical cells suspicious for malignancy. The diagnosis of Hodgkin’s lymphoma was confirmed by immunohistochemical analysis. A staging CT scan of the abdomen and pelvis showed no evidence of mesenteric or retroperitoneal lymphadenopathy. The patient was started on chemotherapy with doxorubicin, bleomycin, vinblastine, and darcarbazine.

DISCUSSION: To our knowledge, about 100 cases of PPHL have been reported. This rare disease can present as a single or multiple lung nodules and rarely as cavitary lung lesions. Given the non-specific clinical and radiological manifestations, patients are often worked-up for infectious or other neoplastic etiologies. Histological and immunohistochemical analysis of biopsy specimens, obtained via endoscopic or thoracoscopic modalities, confirm the diagnosis. The treatment consists of combination of radiation and chemotherapy. Prognosis is largely affected by the extent of lung involvement.

CONCLUSIONS: PPHL should be considered in the differential diagnosis of patients presenting with cavitary lung lesions. Due to prognostic variability, further studies are needed to establish risk factors to determine appropriate therapeutic regimens.

Reference #1: Cooksley N, Judge DJ, Brown J. Primary pulmonary Hodgkin's lymphoma and a review of the literature since 2006. BMJ case reports. 2014;2014:bcr2014204020.

Reference #2: Badyal RK, Sharma P, Prakash G, Malhotra P, Varma N. Hodgkin lymphoma masquerading as tuberculosis in a young chronic smoker. Indian J Hematol Blood Transfus. 2014;30(Suppl 1):428-32

Reference #3: Radin AI. Primary pulmonary Hodgkin's disease. Cancer.1990;65(3):550-63.

DISCLOSURE: The following authors have nothing to disclose: Halim El-Hage, Mohamad Yasmin, Ambreen Khalil

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