Classical Hodgkin’s lymphoma infiltrated both lungs
A 26-year-old male complained of continued cough with small amount of white sputum for more than 2 months and a rapidly growing neck mass for 2 weeks. His medical history and laboratory examination were unremarkable, except routine blood examination showing WBC was 17.56×109/L. Ultrasound detected multiple abnormal enlarged lymph nodes in bilateral neck region, size of the largest one was 40 mm × 28 mm, with clear border, while Color Doppler Flow Imaging (CDFI) showed no obvious blood flow signals (Figure 1). Chest X-ray and CT scan revealed multiple scattered consolidation lesions involving bilateral lungs and many enlarged lymph nodes in the mediastinum and bilateral hilums. Both lymph nodes and pulmonary infiltration lesions slightly enhanced after contrast administration (Figures 2,3). A sarcoidosis or blood system tumor was suspected. After cervical lymph node biopsy, histologic examination and immunohistochemical analysis made the diagnosis of classical Hodgkin’s lymphoma (nodular sclerosis subtype) by finding the diagnostic Reed-Sternberg cells and CD30 positive (Figure 4).
Figure 1. Ultrasound shows one of the enlarged subcutaneous lymph nodes in the cervical region, with clear border, no obvious blood flow signal found by Color Doppler Flow Imaging
Figure 2. Chest X-ray reveals multiple scattered consolidation lesions involving both lungs, showing mass-like features, with different size, mainly on the right lung
Figure 3. Chest axial CT scan (A&B: lung window) demonstrates multiple scattered mass-like lesions in both lungs, with air-bronchogram inside. Chest axial CT scan (C &D: mediastinal window) demonstrates many enlarged lymph nodes in the mediastinum and hilums, slightly enhanced after contrast administration
Figure 4. Photomicrograph showing Reed-Sternberg cells as in ‘Classical Hodgkin’s Lymphoma’ disease on a background of mixed inflammatory cells (H&E staining, original magnification ×400), with immunohistochemical staining showing CD30 positive
Although it is unknown whether this case represents primary pulmonary Hodgkin’s lymphoma or it reflects secondary involvement by nodal Hodgkin’s lymphoma. The rarity of pulmonary Hodgkin’s lymphoma may lead to it being not considered in the differential diagnosis of a pulmonary lesion.
Acknowledgements
Disclosure: The authors declare no conflict of interest.
