Hodgkin lymphoma presenting as multiple cavitary pulmonary nodules with associated mediastinal adenopathy and neck mass

• Published in: Journal of pediatric hematology/oncology Vol. 31; no. 10; p. 730
• Main Authors: Bieliauskas, Shannon, Reyes-Trocchia, Alma, Krasan, Graham P, Main, Charles, Trupiano, Jacqueline K
• Format: Journal Article
• Language: English
• Published: United States 01.10.2009
• Subjects: Adolescent; Biopsy; Diagnosis, Differential; Head and Neck Neoplasms - diagnosis; Head and Neck Neoplasms - pathology; Hodgkin Disease - diagnosis; Hodgkin Disease - pathology; Humans; Male; Mediastinal Neoplasms - diagnosis; Mediastinal Neoplasms - pathology; Multiple Pulmonary Nodules - diagnosis; Multiple Pulmonary Nodules - pathology; Reed-Sternberg Cells
• ISSN: 1536-3678
• DOI: 10.1097/MPH.0b013e3181acd969

Hodgkin lymphoma involving the lung may present in a variety of radiographic and clinical patterns including solid or necrotizing lesions, with or without associated mediastinal adenopathy. Cavitary pulmonary lesions are exceedingly rare, occurring in less than 1% of cases, and are typically solitary. We report a case of an 18-year-old male presenting with multiple cavitating pulmonary nodules and a palpable mass in the neck. Imaging revealed associated mediastinal and cervical adenopathy. Biopsy of the neck mass and lung nodule initially revealed necrosis and granulomata, suggesting infection. Treatment for a presumed infectious etiology was without resolution. Subsequent open lung biopsy revealed marked granulomatous inflammation with diagnostic Reed-Sternberg cells. Hodgkin lymphoma should always be considered in the differential diagnosis of cavitary pulmonary lesions, especially those refractory to treatment.