Pulmonary Hodgkin's Lymphoma Research Articles

Diagnostic and treatment dilemma during the coronavirus disease 2019 pandemic: a primary pulmonary lymphoma presenting as a cavitary mass in a patient with coronavirus disease 2019: a case report

BackgroundA radiological finding of a cavitary pulmonary lesion in a patient acutely infected with severe acute respiratory syndrome coronavirus-2 early during the coronavirus disease 2019 pandemic created a diagnostic and treatment dilemma, as invasive procedures with bronchoscopy and percutaneous needle lung biopsy posed an infection hazard to healthcare workers due to the associated risk of viral aerosolization. Available guidelines recommended delay of non-emergent procedures, but timely proceeding with those deemed urgent provided appropriate personal protective equipment and negative pressure isolation were available and exposure risk was not excessive. Thoughtful consideration by clinicians was required to avoid delay in diagnosis of a potential new malignancy and prevent unnecessary healthcare worker exposure to the virus. Additionally, acute severe acute respiratory syndrome coronavirus-2 infection in patients with malignancy complicated timing of oncologic treatment.Case presentationA 26-year-old otherwise healthy Caucasian male initially presented with an enlarging right upper lobe cavitary pulmonary lesion despite antimicrobial therapy. During his hospitalization and evaluation, the patient was found to be acutely infected with severe acute respiratory syndrome coronavirus-2 without hypoxia or viral pneumonia. Bronchoscopy was deemed too high risk for viral aerosolization and healthcare worker infection. He underwent computed-tomography-guided percutaneous needle biopsy of the lesion by interventional radiology while on mechanical ventilation after elective intubation by anesthesiology. Biopsy revealed classic Hodgkin lymphoma consistent with primary pulmonary Hodgkin lymphoma. After collaboration with oncology, his treatment with combined chemotherapy and immunotherapy was delayed for 3 weeks following diagnosis to allow for viral clearance.ConclusionA careful multidisciplinary strategy is required to expeditiously diagnose and treat aggressive cancers of the respiratory tract in patients acutely infected with severe acute respiratory syndrome coronavirus-2 while observing practices to prevent healthcare worker infection during the ongoing coronavirus disease 2019 pandemic.

Clinicopathological Characteristics of Primary Pulmonary Hodgkin Lymphoma (PPHL): Two Institutional Experiences with Comprehensive Literature Review of 115 PPHL Cases

Primary pulmonary Hodgkin lymphoma (PPHL) is an extremely rare condition. Its clinicopathological characteristics remain unclear because of the limited number of patients with PPHL. The aim of this study was to comprehensively analyze the clinicopathological characteristics of PPHL. We reviewed the electronic medical records and pathology slides of our 10 PPHL patients. The female-to-male ratio was 6:4, and the mean age was 41 years. Although three patients had no symptoms, seven had localized or generalized symptoms, including cough, sputum, chest discomfort/pain, and weight loss. Some cases had not been diagnosed as PPHL in the initial needle biopsy. Four patients underwent surgical resection. With chemotherapy, eight patients achieved complete remission. We also conducted a thorough literature review on 105 previously reported PPHL cases. Among a total of 115 PPHL cases, the most common subtype was nodular sclerosis (37.4%). More than half of the cases (55%) were clinically suspected as infectious pneumonia. Of 61 patients whose biopsies were available, 27 (44.3%) were diagnosed correctly as Hodgkin lymphoma, whereas the misdiagnoses included tuberculosis, Langerhans cell histiocytosis, solitary fibrous tumor, and adenocarcinoma. We demonstrated that PPHL represents a diagnostic challenge on small biopsies. Recognizing that this rare tumor can mimic infectious and inflammatory diseases as well as malignancies is important because the accurate diagnosis of PPHL is essential for adequate clinical management.

Поражение легких при лимфоме Ходжкина

The case of a patient with pulmonary Hodgkin's lymphoma is presented. The disease debuted with respiratory symptoms and radiological signs of the cavitating pulmonary infiltrate with no peripheral lymphadenopathy. The diagnosis was established based on morphological study of the damaged area after lung resection. Whole body PET/CT made it possible to clarify the extent of the tumor by identification of metabolically active peripheral (cervical and axillary) and intrathoracic lymph nodes. The role of morphological and radiological assessment methods in the diagnosis of Hodgkin's lymphoma is discussed.

A decade's experience of pediatric lung abscess and empyema at a community hospital.

Discussions on the diagnostic and management of acquired pediatric lung pathology are usually published by large tertiary children's hospitals. It is likely that much of this pathology is actually seen and managed in nonacademic practices. A 10-year retrospective review of patients under 18-years of age, treated for lung abscesses or empyema was performed. Nineteen empyema and four lung abscesses were included. Presenting symptoms, workup, and management are reviewed. A unique subset (n = 4) of atypical pulmonary pathology is described. A 14-year-old with a vaping history and a lung abscess misdiagnosed as an empyema. A 15-year-old with primary pulmonary Hodgkin's lymphoma presenting as a lung abscess and empyema. A 5-year-old with an empyema complicated by a bronchopleural fistulaand a 21-year-old with autism and an acquired lung cyst. Our dilemmas, experiences, and strategies in managing complex lung disease are generalized to community-based practice.

NOT ALL CAVITARY LESIONS WITH AIR FLUID LEVELS ARE LUNG ABSCESSES

SESSION TITLE: Medical Student/Resident Lung Cancer Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Primary Pulmonary Hodgkin lymphoma is very rare, less than 100 cases have been reported (1,2) as they comprise less than 0.5 % of lung neoplasias (3,4) and of out of those only 2% are PPHL (5). Diagnosis of this neoplasm is very challenging because it usually presents with nonspecific symptoms and radiological images that can be attributed to other etiologies such as infection. CASE PRESENTATION: 26-year-old male presented to his PCP with dry cough, fevers, chills, night sweats, 20-pound unintentional weight loss, and dyspnea for a month. Outpatient treatment with azithromycin for a presumed pneumonia failed and he was admitted to the hospital. He was found to be febrile (39c) and tachycardic (123 beats/min). Laboratory work up was notable for a WBC 25.9. Chest x-ray showed left upper lobe (LUL) lung abscess and left side effusion. He was started on broad spectrum antibiotics. Sputum gram stain was positive for MRSA. CT of the chest showed extensive cavitary necrotic airspace consolidation of the LUL and lingula with moderate left sided pleural effusion(Fig 1). Pleural fluid analysis was found to be exudative in nature. AFB samples were negative. BAL showed gram positive cocci in clusters, however, culture results were negative. Despite antibiotics, the fever persisted, and the patient underwent a second thoracentesis and CT scan that showed progression of the left sided cavitary lesion(2). Repeat bronchoscopy with transbronchial needle biopsy was negative for malignancy. The patient’s symptoms improved, and he was discharged home on antibiotics. One month later the patient was readmitted due to persistent progressive SOB and weight loss. Broad spectrum antibiotics were initiated and repeat BAL was unrevealing. Ultimately, the patient underwent FNA and multiple biopsies around the rim of the LUL “abscess” revealed classical Nodular Sclerosing Hodgkin lymphoma. The patient underwent one cycle of chemotherapy and his symptoms improved significantly, and he was discharged with outpatient follow up. Unfortunately a few months later he presented with the same symptoms and similar CT findings.(Fig 3) DISCUSSION: Cavitary lesions in the lung have a broad differential (6), it is important to consider different etiologies in a patient with recurrent symptoms and non-resolving radiographic abnormalities. Due to the nonspecific signs, symptoms, laboratorial and radiological findings of primary pulmonary lymphomas the diagnosis is very challenging and usually delayed (7, 8) Such as in our case the patient received multiple empirical broad-spectrum antibiotics for suspected abscess without complete resolution of symptoms and progression of radiographic findings. CONCLUSIONS: Our case highlights the importance of considering other differentials for cavitary lung lesions in the treatment plan especially when confronted with a non-resolving symptoms. Reference #1: Rodriguez J, Tirabosco R, Pizzolitto S, et al. Hodgkin lymphoma presenting with exclusive or preponderant pulmonary involvement: a clinicopathologic study of 5 new cases. Ann Diagnos Path 2006;10:83–8 Reference #2: Primary pulmonary Hodgkin's lymphoma and a review of the literature since 2006 Reference #3: Primary Pulmonary Involvement in Mucosa-associated Lymphoid Tissue Lymphoma DISCLOSURES: No relevant relationships by Karim Anis, source=Web Response No relevant relationships by Victor Zavala, source=Web Response

Pulmonary Hodgkin lymphoma: report of one case and review of literature

目的 探讨肺霍奇金淋巴瘤（HL）患者的临床特点。 方法 报道1例原发于肺的HL患者的临床表现、诊断治疗及随访，并进行相关文献复习。 结果 经皮肺穿刺活组织病理检查，结合临床表现和影像学分析，有助于尽早明确诊断，治疗采用表柔比星+博来霉素+长春地辛+达卡巴嗪（ABVD）方案，疗效满意。 结论 原发于肺的HL少见，影像学无特异性征象，临床不易判断，早期在CT引导下经皮肺穿刺，对确定诊断有明确作用。

Assessment of the efficiency of Brentuximab Vedotin in patients with pulmonary Hodgkin Lymphoma by the mean of neutrophil to lymphocyte ratio

Abstract Background Lung involvement, an uncommon initial presentation of Hodgkin Lymphoma (HL), may appear as primary or secondary pulmonary HL. Although the combination of Brentuximab vedotin (BV) with AVD is suggested as an alternative treatment to combinations including bleomycin for patients with pulmonary involvement. The efficacy and adverse effects of BV have not been specialized on pulmonary HL. There is insufficient data about neutrophil to lymphocyte ratio (NLR) of cases treated with BV. We performed this retrospective study to evaluate the efficacy and toxicity of BV in patients with pulmonary HL and to demonstrate the prognostic role of NLR in patients treated with BV. Methods Data of 10 CD 30 (+) HL patients who treated with BV between years 2011–2016 were analyzed retrospectively. Relapsed cases after autologous bone marrow transplantation (ABMT) and/or resistant cases to at least two lines of chemotherapy, and treated with BV were included in the study. Results Patients underwent a median of 8.5 cycles BV. Eight patients (80%) achieved an objective response including 2 of them (20%) with complete response and six of them (60%) with a partial response at the end of the 3rd cycle. At a median follow-up of 16.8 months, median progression-free survival for all patients was 6 months and 3 patients died because of progression. BV, as a single agent, revealed well response in HL cases with pulmonary involvement and other clinical types. No pulmonary toxicity has been occurred due to BV. NLR was found to be o good indicator of prognosis and mortality in pulmonary HL patients and other HL patients. While NLR was not influenced by BV, it can be suggested as an easy prognostic marker in patients treated with BV. Conclusion BV may be used as a bridge therapy to the next curative treatment in order to obtain minimal tumor burden in pulmonary HL patients, and NLR can be used as a prognostic marker in these patients. We believe that this study contributes the current literature in terms of being the first research on the referred issue.

Secondary Pulmonary Hodgkin Lymphoma of the Lung: A Case Report

Secondary Pulmonary Hodgkin Lymphoma of the Lung: A Case Report

Primary Pulmonary Hodgkin Lymphoma Associated with Primary Sjögren's Syndrome

An 84-year-old woman was admitted due to a 2-week history of cough and fever. At 65 years of age, she was diagnosed with primary biliary cirrhosis (PBC) and was successfully treated with ursodeoxycholic acid (600 mg/day) since then. At 81 years of age, she had visited our hospital because of Raynaud’s phenomenon and arthralgia. Her laboratory findings at that time were as follows: white blood cell count, 7,340/μL; (neutrophils, 66.5%; basophils, 0.3%; eosinophils, 4.1%; lymphocytes, 23.6%; monocytes, 5.5%); aspartate aminotransferase, 29 U/ L; alanine aminotransferase, 34 U/L; alkaline phosphatase, 303 U/L; gamma glutamyl transferase, 46 U/L; lactate dehydrogenase (LDH), 253 U/L (normal range, 115 to 245 U/L); Creactive protein, 0.20 mg/dL; immunoglobulin G (IgG), 1,661 mg/dL (normal range, 870 to 1,700 mg/dL); IgM, 595 mg/dL (normal range, 35 to 220 mg/dL); IgA, 402 mg/dL (normal range, 110 to 410 mg/dL); C3, 115 mg/dL (normal range, 80 to 140 mg/dL); C4, 29 mg/dL (normal range, 17 to 45 mg/ dL); and rheumatoid factor, 34 IU/L (normal value, <15.0 IU/ Ewha Med J 2016;39(3):95-98 http://dx.doi.org/10.12771/emj.2016.39.3.95 pISSN 2234-3180 • eISSN 2234-2591 Images and Solution

Primary Pulmonary Hodgkin's Lymphoma: A Rare Etiology of a Cavitary Lung Lesion

Primary Pulmonary Hodgkin's Lymphoma: A Rare Etiology of a Cavitary Lung Lesion

Pulmonary hodgkin lymphoma in a patient with Crohn's disease.

Classical Hodgkin lymphoma (HL) accounts for approximately 4.5% of all lymphomas in Korea. It is almost always a nodebased lymphoma, and a primary extranodal manifestation of this disease is unusual. Interestingly, patients with a history of inflammatory bowel disease (IBD) who are treated with immu nosuppressants have been noted to have an increased risk of lymphoma; most cases that have been identified in this setting in volve non-Hodgkin lymphoma (NHL). There have been few reported cases of primary intestinal HL in Crohn’s disease (CD) patients, 1 and the development of extraintestinal HL in patients with CD has been reported even less frequently. 2,3 Herein, we

Primary Pulmonary Hodgkin's Lymphoma: Two Case Reports

Hodgkin’s lymphoma presenting as a primary pulmonary lesion is rare with an incidence of 3.6% in extranodal lymphomas. It needs to be distinguished from nodal Hodgkin’s lymphoma and malignancies secondarily involving the lung. It disseminates in the later stages and involves other lymph nodes and organs early and prompt diagnosis is important. We here present two such cases diagnosed as primary pulmonary Hodgkin’s lymphoma in young adult females who presented with nonspecific complaints.

Pulmonary lymphocyte-rich classical Hodgkin lymphoma with early response to ABVD therapy

Dear Editor, Pulmonary Hodgkin lymphoma is a rare subgroup of Hodgkin lymphoma which primarily affects the lung with minimal extrapulmonary lesions [1]. The disease manifests as multiple nodules or, less frequently, as a solitary mass in the pulmonary parenchyma [2]. The histological spectrum of pulmonary Hodgkin lymphoma resembles that of nodular Hodgkin lymphoma; nodular sclerosis and mixed cellularity account for common subtypes, while lymphocyte-rich classical Hodgkin lymphoma (LRCHL) is much less frequent. A meta-analysis of 61 cases with pulmonary Hodgkin lymphoma identified only one case (2%) of LRCHL [1]. Therefore, LRCHL with primary pulmonary lesions is extremely rare. We herein describe another case of pulmonary LRCHL and discuss the optimal treatment strategy which has not yet been determined. A 35-year-old female presented with a 2-month history of progressive nonproductive cough and intermittent fever. Physical examination detected mild enlargement of a left supraclavicular node. Laboratory test results included hemoglobin level of 110 g/L and leukocyte count of 10.4× 10 /L. Chest radiograph was remarkable for multiple parenchymal nodules in both lungs (Fig. 1a). Transbronchial biopsy of a nodule did not reach a diagnosis although microscopic examination showed dominant infiltration of lymphocytes. Open biopsy of a supraclavicular node was also performed, and histopathology was notable for a vague nodular lesion with scattered binuclear large cells in the background of smallto medium-sized lymphocytes without neutrophils or eosinophils (Fig. 1b). Immunophenotype of the large cells was CD30+, CD15+ (partial), and CD20−, consistent with Reed–Sternberg (RS) cells. She was then referred to us for further scrutiny and treatment. F-18 fluorodeoxyglucose positron emission tomography (FDGPET) combined with computed tomography (CT) scan revealed uptakes in multiple pulmonary nodules, mediastinum, supraclavicular lymph nodes, hepatic hilar lymph nodes, and splenic nodules (Fig. 1c, d). There was no evidence of granulomatosis, sarcoidosis, carcinoma, or infection. Taken together, the patient was diagnosed as pulmonary LRCHL with nodal and splenic involvement. Treatment was initiated with six cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) regimen. Interim F-18 FDG-PET/CT scan after two cycles disclosed salient regression of parenchymal nodules and complete resolution of the extrapulmonary lesions (Fig. 1e, f). The patient has so far been relapse-free for 14 months. In the pre-ABVD era, pulmonary Hodgkin lymphoma was associated with relatively dismal outcomes. In one study, mechlorethamine, vincristine, procarbazine, and prednisolone (MOPP) therapy resulted in a relapse rate of 56% (five of nine cases) [2]. This series included one case of relapsed pulmonary LRCHL. These results are partly explained by the inability to use radiotherapy for pulmonary parenchymal lesions. Our case was featured by early response of pulmonary lesions to ABVD therapy. This regimen was superior to MOPP therapy as first-line treatment A. Honda : F. Nakamura :Y. Nannya :M. Ichikawa : M. Kurokawa (*) Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan e-mail: kurokawa-tky@umin.ac.jp

Primary pulmonary Hodgkin Lymphoma simulating a mediastinal tumour: an uncommon occurrence.

The case of a patient with primary pulmonary Hodgkin Lymphoma simulating a mediastinal tumour is reported for its rarity and the diagnostic concerns encountered by us.

Diagnostic difficulties caused by a pulmonary infiltrate

Lung infiltration still causes differential diagnostic difficulties, which may delay the start of definitive treatment. The examination of a 30-year-old man began due intermittent, remittent and permanent fever. Chest X-ray confirmed infiltration in the right upper lobe, which was accompanied by elevated CRP and physiological levels of procalcitonin. Most likely atypical pneumonia, tuberculosis, Wegener's granulomatosis or a malignant process was suspected. Throughout his examination infection could not be verified, repeated CT guided transthoracic needle biopsy suggested the possibility of a malignant process. Through surgical exploration the intraoperative histology was not informative; thus, the pneumonitis-remodelled right lung was removed due to the possibility of malignant transformation. Histological examination revealed lymphocyte rich classical Hodgkin lymphoma, which was found to be stage IV/B based on the 18FDG-PET/CT scan; therefore, eight cycles of ABVD (adriablastin, bleomycin, vinblastine, and dacarbazine) therapy was administered successfully. The patient is currently (for 30 months) in a complete metabolic remission. Primary pulmonary Hodgkin lymphoma is a rare disease entity (in this case it might be the original process), in which the diagnosis is often difficult. 18FDG-PET/CT may be a useful early diagnostic tool investigating fever of unknown origin.

Pediatric pulmonary hodgkin lymphoma: Analysis of 10 years data from a single center

Several reports indicate that lungs are the extralymphatic site most commonly affected in patients with Hodgkin lymphoma; however, the data in children are rather limited. This retrospective study aimed to assess the frequency, clinical picture, and the impact on prognosis in children with pulmonary Hodgkin lymphoma, who were diagnosed and treated in a single center during a 10-year period. Pulmonary lesions related to HL: nodules and parenchymal infiltrates with cavitations were found in 3 of 32 (9.4%) patients; in 2 cases these were found as the concomitant manifestation whereas in 1 case as the solitary form (Primary Pulmonary Hodgkin Lymphoma). B-DOPA and MVPP chemotherapy combined with mediastinal and pulmonary irradiation resulted in sustained remissions in all 3 patients, lasting 3, 7, and 64 months, respectively. Lung involvement occurs in up to 10% of children with Hodgkin lymphoma. Primary pulmonary Hodgkin lymphoma is a rare and atypical form of Hodgkin lymphoma; thus is associated with delayed diagnosis which does not seem to affect prognosis. It should be suspected in a child with non-resolving pneumonia and pulmonary parenchymal infiltrates with cavitations.

Coexistence of primary pulmonary Hodgkin lymphoma and gastric MALT lymphoma associated with Epstein-Barr virus infection: A case report

We describe a 66-year-old woman with Epstein-Barr virus-associated lymphoproliferative disorder with lung and gastric tumors. We identified two lung tumors measuring 13 and 20 mm in diameter that consisted of CD30-, CD15-, and CD20-positive Hodgkin- and Reed-Sternberg-like cells and heterogeneous cellular infiltrates in a pronounced nodular pattern, with necrosis and vasculitis, diagnosed as nodular sclerosis classical Hodgkin lymphoma. A gastric tumor showed low-grade extranodal marginal zone B-cell lymphoma of the mucosa-associated lymphoid tissue type. Neoplastic cells in all tumors expressed Epstein-Barr virus-encoded RNA based on in situ hybridization. The present case is a rare composite lymphoma arising from different extranodal organs, associated with EBV infection. Her medical history included gamma-knife therapy for clinical diagnosis with a suspicion of cerebral lymphoma.

Primary pulmonary Hodgkin's lymphoma: A rare pitfall in transthoracic fine needle aspiration cytology

Primary pulmonary Hodgkin's lymphoma (PPHL) is extremely rare. At an extranodal location such as the lung this lymphoma is likely to be confused with the more commonly occurring carcinomas at this site. We report the fine needle aspiration cytology (FNAC) findings of a PPHL in a 36-year-old male with a view to discuss the pitfalls and clues to the accurate cytologic diagnosis. This patient presented with a large, heterogeneously enhancing mass involving the anterior segment of right upper lobe without any evidence of nodal involvement. A CT-guided transthoracic FNAC of this mass revealed large connective tissue fragments with entrapped voluminous cells amidst a polymorphous population of eosinophils, polymorphs, and lymphocytes. The large cells showed abundant often stripped off cytoplasm, an irregular nucleus with nucleolus and were initially diagnosed as non-small cell carcinoma of the lung. In view of the locally advanced stage, patient received a carboplatin and gemcite-based chemotherapy with complete response but postchemotherapy patient refused local surgery. Two years later, the patient developed enlarged nodes which were diagnosed as Hodgkin's lymphoma, and a review of prior lung tumor confirmed the diagnosis of PPHL. Hence the rare diagnosis of PPHL should be kept in mind when a cytopathologist observes large cells embedded in collagenous tissue fragments with dominant cell dispersal amidst an inflammatory infiltrate in an aspirate from a primary lung tumor.

Granulomatose lymphomatoïde dans les suites d’une leucémie aiguë myéloïde

We report a case of lymphomatoid granulomatosis (LG), arising in a 60-year-old man in the setting of an acute myeloid leukemia. LG is a rare Epstein Barr virus (EBV) lymphoproliferative disorder, generally occurring in a context of immunodeficiency. Patients usually present with respiratory symptoms and bilateral pulmonary nodules. Histologically LG is characterized by an angiocientric and angiodestructive lymphoproliferation of B/EBV+ cells admixed with numerous reactive T cells. The differential diagnosis mainly includes pulmonary vasculitis and Hodgkin's lymphoma. The outcome of this lymphoproliferation is highly variable, ranging from an indolent process to an aggressive large cell lymphoma.

Hodgkin's Lymphoma Mimicking Necrotizing Pneumonia: Case Report

This study describes a case of pulmonary Hodgkin's lymphoma of the nodular sclerosing type presenting as a large cavitary mass with air-fluid levels. We also conduct a review of the previous articles on pulmonary Hodgkin's lymphoma.