Hodgkin’s lymphoma of nodular sclerosis subtype, stage IVBX
Journal Title: Αρχεία Ελληνικής Ιατρικής - Year 2008, Vol 25, Issue 5
Abstract
A 36-year-old man was admitted to our Hospital because of dry cough, general malaise, lymphoadenopathy, and fever. The patient had no history of rash, night sweats, fevers, anorexia, fatigue, weight loss, cough, nausea, vomiting, urinary difficulties, constipation, easy bruisability, or bleeding. His maternal grandfather had had prostate cancer. Indeed, the patient had been well until 11 months earlier, when worsening pruritus occurred, especially during the day, when the patient felt flushed and sweaty; an antihistamine was ineffective. He occasionally had a sensation of pressure in his chest and difficulty taking a deep breath, although he did not have dyspnea or orthopnea. The temperature was 37.6 °C, the pulse was 102 beats per minute, and the respiratory rate was 21 breaths per minute. The blood pressure was 145/90 mmHg. The physical examination detected excessive lympadenopathy (>10 cm) in both posterior cervical triangles, mainly in the left (fig. 1). A coarse crackle in the bilateral medium and lower lung was detected, while the oxyhemoglobin saturation was reduced at the level of 88% in room air. The full blood count was as follows: Ht 36.8%, Hb 11.7 g/dL, WBC 13.2×109/L (differential count %: neutrophils 74, band forms 6, lymphocytes 8, monocytes 8, eosinophils 4) and platelet count 482×109/L. The erythrocyte sedimentation rate was 67 mm/1h, serum C-reactive protein was 16 mg/dL, lactate dehydrogenase was 285 U/L (UNL 240 U/L) and the potassium was 3.3 mmol/L. All other biochemical parameters were within normal range. A chest roentgenogram showed an enlargement of the superior mediastinal due to a mass which was extended to the left lung; further bronchovascular lymphangitis-like shadows were present in both lungs (fig. 2). CT-scan of the thorax detected extensive lymphadenopathy in the superior mediastinal, prevascular, paratracheal, and subcarinal regions and in the hilar regions bilaterally. Multiple nodules were evident in both lungs; the largest in the right lower lobe was 1.5 by 1.1 cm, and the largest in the left upper lobe was 1.2 by 1.1 cm. The airways, heart, and great vessels were normal, and no pleural or pericardial effusion was seen. The abdomen CT showed scattered small, lowattenuation lesions in the liver and spleen. The biliary ducts were not dilated, while the kidneys, gallbladder, pancreas, and adrenal glands appeared normal. A lymph-node, 1.8 by 2.0 cm was adjacent to the left iliac muscle. The pelvic organs were unremarkable. Lymph-node aspiration from the left posterior cervical triangle revealed the presence of large bilobed cells (fig. 3), while a proper lymph-node biopsy from the same area was also performed. Furthermore, a bronchoscopy with cytologic brushings was subsequently carried out and the cytologic analysis demonstrated isolated large mono- to bi-nucleated and some multinucleated cells in a background of mixed inflammatory cells and bronchial epithelium. The examination of specimens from a bone marrow biopsy and aspiration disclosed myeloid hyperplasia with increased eosinophil counts but no evidence of a malignant process. The biopsy of the lymph-node established the diagnosis and the patient treated with appropriate therapy.
Authors and Affiliations
S. MASOURIDI, A. SARANTOPOULOS, E. CHATZILEONIDA, P. KOUZIS, J. ASIMAKOPOULOS, M. THEOCHARI, N. VINIOU, K. KONSTANTOPOULOS
Keywords
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