Medistinal lymphoma

Case contributed by Abdulmajid Bawazeer
Diagnosis certain

Presentation

The patient came complaining of cough for three months with chest tightness. No hemoptysis.

Patient Data

Age: 30 years.
Gender: Female
x-ray

Well defined mediastinal opacity occupying part of the anterior and middle mediastinum and causing a widening of right and left paratracheal stripes.
Obliteration of right CP angle.
Mild shifting of trachea to the left side.

ct

Well-defined lobulated heterogeneously enhancing soft tissue mass lesion in the anterior and middle mediastinum with extension to retrosternal and lower neck with no calcification, hemorrhage, or fat component.
The previously mentioned mass encasing ascending and aortic arch, innominate, right subclavian, and carotid arteries as well as encasing and severely narrowing SVC, azygos, right brachiocephalic veins with collaterals in the right upper neck and intercostal space along with abutting the superior aspect of the right pulmonary artery, (superior vena cava syndrome).
Deviated trachea to the left side.
Right supraclavicular and lower cervical lymph nodes.
Right-sided pleural effusion.
 

ct

BIopsy was obtained through the first right intercostal space under CT scan guidance for histopathology evaluation.

 

Case Discussion

The pathology report illustrates proliferation of lymphoid cells with areas of wide fibrosis in between.
The lymphocytes are mostly small CD3 positive and few CD20 positive with scattered eosinophils in between, and few large Reed-Sternberg-like cells.
These features are highly suspicious of Hodgkin lymphoma.
 

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