Primary pulmonary Hodgkin's disease with air bronchogram

Primary pulmonary Hodgkin's disease and tuberculosis in an 11-year-old boy: case report and review of the literature

Tuberculosis (TB) has been described in association with different malignancies including Hodgkin's disease. However, the association with primary pulmonary Hodgkin's disease (PPHD) is hardly reported in literature and in teenage is quite exceptional. We report a case of an 11 years old boy in whom the diagnosis of tuberculosis preceded and delayed the diagnosis of PPHL.

Primary Hodgkin's disease of the lung

Three cases of Hodgkin's disease presenting primarily in the lung are described. All 3 patients presented with respiratory symptoms and chest X-rays revealed discrete masses within the lung parenchyma. CT examination of the mediastinum did not reveal regional or generalized lymphadenopathy at the time of diagnosis in 2 of the cases. A diagnosis of Hodgkin's disease was made on open lung biopsies and despite aggressive chemotherapy, 2 patients died within 2 yrs. The histological and immunocytochemical features of these cases were typical of that expected in Hodgkin's disease. However, the stated indolent course of primary pulmonary Hodgkin's disease is not invariable. Those patients with bilateral interstitial disease and systemic symptoms have a poor prognosis. Furthermore, it is difficult to exclude definitely lymph node involvement (although not enlarged) at the time of diagnosis. Since several cases described in the literature have concurrent and/or subsequent nodal involvement, the entity of primary pulmonary Hodgkin's disease without lymph node involvement is exceedingly rare.

Primary pulmonary Hodgkin's disease

Primary pulmonary Hodgkin's disease is a rare but distinct entity, to be distinguished from nodal Hodgkin's disease and from lymphomas involving the lung secondarily. Sixty-one cases have now been reported in the world's literature. This lymphoma affects women more frequently than men, and typically involves the superior portions of the lungs. Radiologically, it appears as a solitary mass or multinodular disease; inhomogeneity or cavitation of these lesions are common. Since the presentation of this disease is nonspecific, and as noninvasive tests are rarely revealing, diagnosis requires an open thoracotomy and lung biopsy. Factors which correlate with a poorer prognosis include "B" symptoms, bilateral disease, multilobe involvement, penetration of the pleura, and cavitation. The staging and treatment of these lymphomas according to the extent of pulmonary involvement are recommended, as radiotherapy or combination chemotherapy may be effective in appropriately selected patients.