Diagnostic DilemmaSerious Cover-Up: Hodgkin's Lymphoma Masked by Organizing Pneumonia
Section snippets
Presentation
A biopsy indicated that the patient had organizing pneumonia, but after several months a second biopsy more clearly demonstrated malignancy. A 20-year-old woman was admitted with complaints of hemoptysis and chest discomfort. Her symptoms began 2 weeks before hospitalization, with a dry cough and occasional episodes of vomiting.
Assessment
The patient's vital signs were normal, and her oxygen saturation was 98% on room air. She had a 1-cm firm, nontender, left cervical lymph node and a midline trachea with no adventitious breath sounds. The rest of her examination was unremarkable.
Laboratory testing revealed a neutrophil-predominant leukocytosis and an elevated level of C-reactive protein. Pulmonary function tests measured a forced vital capacity of 2.2 L, which was 58% of the predicted value, and her first forced expiratory
Diagnosis
The return of the patient's symptoms and the enlarged lung mass warranted a repeat open lung biopsy via thoracotomy. Histopathologic sections from the second procedure demonstrated lung parenchyma with a vaguely nodular proliferation composed of small lymphocytes, eosinophils, and neutrophils. Mixed in were scattered, large, atypical cells with round to irregular hyperchromatic nuclei, vesicular chromatin, inclusion-like nucleoli, and abundant amounts of cytoplasm, findings consistent with
Management
Our patient's circumstances highlight the importance of re-evaluation when the clinical or radiologic course changes, even after establishing a histopathologic diagnosis and obtaining a good initial response to treatment. In retrospect, whether taking multiple wedge biopsy specimens from the initial lung mass and/or a sample from the palpable lymph node would have changed the patient's course is debatable. Because the symptom profile of these 2 diseases can overlap, a high index of suspicion is
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Cited by (0)
Funding: None.
Conflict of Interest: None.
Authorship: AL: Data collection, primary draft of manuscript, image selection, and revision of Manuscript. MJD: Review of manuscript and data collection. JA: Data collection, image selection, and review of manuscript. YC: Data collection, image selection, and review of manuscript. SD: Inception of study and critical review of manuscript.