Primary Pulmonary Classical Hodgkin Lymphoma with Two Recurrences in the Mediastinum : A Case Report

Abstract

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. 〔J Clin Exp Hematopathol 50(2) : 151-157, 2010〕

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

“…Immunohistochemistry provides the definitive diagnosis in histopathologically indistinct cases 25. PPHL tumour cells are positive for CD15, CD30, Pax5 and rarely CD20, and negative for T-cell markers 26 27. The most considered diagnoses in the current case were tuberculosis, congenital adenoid cystic malformation on the basis of radiology and Langerhans histiocytosis on the basis of the initial histopathology.…”

Lymphoproliferative Neoplasms of the Lung: A Review

“…Immunohistochemically, the tumor cells are positive for CD15, CD30, Pax5, and rarely CD20, and negative for Tcell markers. 21,72 Factors that correlate with a poor prognosis include age greater than 60 years, B symptoms, multiplicity and bilaterality of lung lesions, pleural effusion, and cavitation. 73 It is suggested that chemotherapy is recommended over radiotherapy in this disease because of the risk of radiation pneumonitis.…”

Primary Pulmonary Hodgkin's Lymphoma: Two Case Reports

“…Less than 100 cases have been reported in the literature so far [1]. It has a bimodal age distribution with peak incidence being in the third and sixth/seventh decade and a female predominance [3].…”

“…Fewer than 100 cases have been reported in the literature so far [1]. It is a discrete entity which needs to be distinguished from nodal Hodgkin's disease and from lymphomas secondarily involving lung [2].…”