Presentation
Hemoptysis and weight loss.
Patient Data
Large left upper lobe mass abutting the mediastinum. Left sided volume loss with tenting of the left hemidiaphragm.
Large left upper lobe mass, with patchy opacity peripherally. Truncation of the left upper lobe bronchus. Extends to the mediastinum with enlarged mediastinal nodes.
Patient underwent image-guided core biopsy of the lung mass.
Histopathology
MICROSCOPIC DESCRIPTION: The core biopsy shows scattered nodular lymphoid aggregates, surrounded by fibrous tissue. No normal lung parenchyma is present. Within the aggregates are single large atypical cells. They have enlarged hyperchromatic nuclei, occasional bi to multinucleation, prominent nucleoli and scanty cytoplasm. The background contains scattered eosinophils and small mature lymphocytes. No granulomas are noted. The atypical cells are CD30, MUM1 and PAX-5 positive. The large cells appear to be EBER-CISH positive despite the rather strong background staining. 2 cells are CD20 positive with complete membranous staining. They are CD3, CD10, CD15, CD45, OCT2, BOB1, CAM5.2, EMA, TTF-1, c-kit, PLAP, ALK-1 and TdT negative. The features are those of classical Hodgkin lymphoma.
DIAGNOSIS: Classical Hodgkin lymphoma.
Case Discussion
Pulmonary involvement in Hodgkin lymphoma is rare occurring in 5-12% of patients, and typically represents advanced disease.
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