CHEST Guidelines-A-52-Year-Old-Woman-With-Shortness-of-Breath-and-L

A-52-Year-Old-Woman-With-Shortness-of-Breath-and-L

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A 52-year-old woman with a history of smoking presented with progressive shortness of breath and intermittent left lower back pain over six months. Despite initial treatment with antibiotics for suspected pneumonia, her symptoms persisted. Clinical examinations revealed normal vital signs but indicated wheezing and crackles in the left lung. Imaging studies, including a CT and PET scan, identified mass-like consolidations in her left lung lobes with high fluorodeoxyglucose uptake, suggestive of malignancy. Surprisingly, routine lab tests and bronchoalveolar lavage cultures were unremarkable.<br /><br />Further diagnostic procedures, including bronchoscopy and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), revealed a polymorphous inflammatory infiltrate with atypical lymphocytes. Immunohistochemical staining showed positivity for CD15, CD30, and PAX-5, consistent with Hodgkin lymphoma. The final diagnosis was Primary Pulmonary Hodgkin Lymphoma (PPHL), a rare form of Hodgkin lymphoma confined to the lung.<br /><br />PPHL constitutes less than 1% of primary lung cancers and symptoms can be nonspecific, often resembling other pulmonary conditions. Accurate diagnosis relies on histopathological examination and exclusion of extrapulmonary disease. Traditional diagnostic methods have limitations, but transbronchial cryobiopsy was highlighted as a valuable tool, offering larger tissue samples for comprehensive analysis.<br /><br />The patient received chemotherapy with a regimen starting with doxorubicin, bleomycin, vinblastine, and dacarbazine, which showed significant improvement. Her treatment was adjusted to include rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone. She remained disease-free 15 months post-diagnosis.<br /><br />This case underscores the diagnostic challenges of PPHL and highlights the efficacy of transbronchial cryobiopsy in obtaining adequate tissue samples for diagnosing complex pulmonary conditions. The favorable prognosis with appropriate treatment was evidenced by the patient's positive response to chemotherapy.

Keywords

Primary Pulmonary Hodgkin Lymphoma

PPHL

Hodgkin lymphoma

transbronchial cryobiopsy

chemotherapy

immunohistochemical staining

diagnostic challenges

pulmonary conditions

CD15 CD30 PAX-5

doxorubicin bleomycin vinblastine dacarbazine