Lung Cancer: Thoracic Malignancies |

Secondary Pulmonary Hodgkin Lymphoma of the Lung: A Case Report FREE TO VIEW

Yaoqian Cao, MHA; Jie Cao, MHA; Haiyan Zhao, PhD
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Tianjin Medical University General Hospital, Tianjin, China

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A333. doi:10.1016/j.chest.2016.02.346
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SESSION TITLE: Thoracic Malignancies

SESSION TYPE: Case Report Slide

PRESENTED ON: Sunday, April 17, 2016 at 04:00 PM - 05:00 PM

INTRODUCTION: Lung is relatively common position of secondary involvement of lymphoma. These patients may occur prior or concurrent nodal lesions or evolve to systemic lymphoma up to 6months after presentation. But there are few reports on secondary pulmonary lymphoma.

CASE PRESENTATION: A 26 year man presented with nonproductive cough one monthly ago, andwas taken anti-infective treatment with more severe symptoms again. A chest scan demonstrated multiple nodular and mass on both left and right of the lung, complicated with bilateral hilar and mediastinal lymphadenopathy (Figure 1). The moist rale of bilateral respiratory was not auscultated. His peripheral blood cell count did not show marked difference. Tumor markers including SCC-Ag, CYFRA, NSE, and CEA were unremarktable. A bronchoscopic exam revealed a white necrotic material in the back segment of bronchus of the left inferior lobe that was taken the transbronchial lung biopsy (TBLB) (Figure 2). The cellcular degeneration and necrosis were merely discovered by ROSE (Figure 3). A bronchial pathology showed scattered large cells with hyperplasia lymphocytes (Figure 4). Immunohistochemistry (IHC) staining was positive CD15, CD30, and PAX5 with background cell CD3. Cytological specimens gained by TBNA showed the dyskaryotic cell.

DISCUSSION: Pulmonary lymphoma is classified as the primary pulmonary lymphamo (PPL) and secondary pulmonary lymphamo (SPL) on the basis of lnvolvement form, and diagnosis of lymphoma is relied on the morphologic, immunologic, pathological, and genetic features[1]. Mediastinal node enlargement in patient with SPL is the most characteristic manifestation on chest imaging (2,3). Combining with chest scan, pathological findings and immunohistochemical feature, pulmonary HL was considered in this case. However, SPL was not almost possible to distinguish from PPL according to pathological result due to the same morphology. Taking medical history entirely, he was diagnosed with Hodgkin lymphoma (HL) because of painless enlargement of supraclavicular lymph nodes a year ago. He was performed by eight courses of chemotherapy and autologous stem cell transplantation (ASCT) during this period. In our case, the tumor cells were positive for CD15, CD30, PAX5, and occasionally CD20. So this case was compatible with sencondary pulmonary HL.

CONCLUSIONS: A biopsy including bronchoscopy, CT-guided transthoracic needle aspiration, open or video-assisted thoracoscopy, and TBNA is carried out as soon as possible if patients are highly considered as pulmonary lymphoma.

Reference #1: William J, Variakojis D, Yeldandi A, et al. Lymphoproliferative neoplasms of the lung: a review. Arch Pathol Lab Med. 2013 Mar;137(3):382-91

Reference #2: S S HARE, C A SOUZA, G BAIN, et al. The radiological spectrum of pulmonary lymphoproliferative The British Journal of Radiology, 85 (2012), 848-864

Reference #3: Fujisawa T, Suda T, Matsuura S, et al. Peripheral T-cell lymphoma with diffuse pulmonary infiltration and an increase in serum KL-6 level. Respirology. 2007;12(3):452-454.

DISCLOSURE: The following authors have nothing to disclose: Yaoqian Cao, Jie Cao, Haiyan Zhao

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