Presentation
Fatigue, anorexia, fever and lateral chest pain in a non-smoker.
Patient Data
Cervical VB chain necrosed lymph nodes are associated with multiple enlarged mediastinal lymph nodes which have a mass effect on mediastinum structures. Some of these lymph nodes are centrally necrosed.
Bilateral pleural effusions and small pericardial effusion.
Internal thoracic lymph nodes enlarged.
Thrombosis of the left internal jugular vein and the left subclavian vein.
On the lung window, there is irregular interlobular septal thickening of the left lung suggesting lymphangitis carcinomatosis or lymphatic obstruction.
Pathology: lymphomatous tumor proliferation with necrosis formed by lymphocytes, plasmocytes, eosinophils and Reed-Sternberg-like cells.
The immunohistological study showed strong paranuclear dot expression of CD30 by tumor cells and rarely expressed CD15. Tumor cells are negative for CD3, CD20, CD23 and CK.
The residual lymphocytes were essentially T type so mediastinal Hodgkin lymphoma was diagnosed.
Case Discussion
For pleural effusion in a non-smoking young adult, we think about tuberculosis.
If there is a widened mediastinum associated we must think about mediastinal mass.
To have more information about the suspected mass and the extension, a cervico-thoraco-abdominal CT scan is necessary.
Transthoracic needle biopsy or other methods must be discussed for diagnosis.
US is a good way to explore pleural effusion and to visualize masses with a parietal extension.
To complete staging of Hodgkin lymphoma we must do a biopsy and a PET-scan.
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