Thoracic Hodgkin lymphoma

Case contributed by Dr Akshit Aiyappa M J

Presentation

Presented with cough with expectoration since 1 month. Breathlessness and generalized weakness since 1 week.

Patient Data

Age: 20 years
Gender: Male
X-ray

Frontal and lateral chest x-ray reveals a well defined soft tissue density lesion on left side with broad base to mediastinum. This is seen to obliterate left heart border. 

Patchy non homogenous opacities noted in right lung field, predominantly in mid and lower zones.

CT

Fairly well defined heterogeneously enhancing lesion noted in the anterior mediastinum extending into the middle mediastinum. This is seen to abut cardia, left pulmonary artery, adjacent pulmonary veins and anterior chest wall. This is also seen to cause the collapse of the underlying lung. The lesion is seen to compress the left main pulmonary artery and left main bronchus. 

Parenchymal opacities with air bronchogram noted in right middle and lower lobes and left lower lobe - suggestive of consolidation.

Impression: Lymphoma vs thymoma.

PET revealed metabolically active disease in anterior mediastinum on left side compressing adjacent lung parenchyma; multiple hypermetabolic mediastinal, right hilar, bilateral supraclavicular, right axillary, left cardiophrenic, gastrohepatic and abdominal lymph nodes.

Case Discussion

The patient underwent CT guided biopsy of the mediastinal lesion, which was suggestive of thymoma subtype AB (composed of lymphocyte rich and lymphocyte poor areas). In view of unresolving right lung consolidation, PET CT was advised, which was in favor of lymphoma with metastases. Ultrasound-guided supraclavicular lymph node biopsy was performed. 

Supraclavicular lymph node biopsy impression: Nodular sclerosis - Classic Hodgkin Lymphoma

  • CD45 - Negative in RS cells and diffusely positive in the background lymphoid cells
  • CD15 - Focally positive in RS cells
  • CD30 - Positive in RS cells

IHC findings confirmed the histological diagnosis of classical Hodgkin lymphoma

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