Primary pulmonary Hodgkin lymphoma presenting as multiple cystic lung lesions: diagnostic usefulness of cell block

Abstract

Classic primary pulmonary Hodgkin lymphoma (PPHL) is a rare event usually presenting as single or multiple nodules and more rarely as multiple cystic lesions. A patient affected by PPHL is often debilitated with impaired cardiorespiratory function and not suitable for invasive procedure to acquire a biopsy sample for histological diagnosis. Transthoracic ultrasound-guided fine needle aspiration (TUS-FNA) is a non-invasive procedure which gives the possibility to obtain a cytological sample that can be used to perform cell-block (CB). CB preparation can provide a diagnostic sample useful for additional analysis, such as immunocytochemical studies and molecular profiling. | C A S E HIS TORYA 18-year-old woman, without previous oncological history, presented to our Institution with fever, weight loss, dyspnoea and asthenia. At clinical evaluation, decreased air entry and fine crepitations at right upper pulmonary zone were present. Blood count was within normal limits. Erythrocyte sedimentation rate (120 mm/h) and C-reactive protein (20 mg/dL) were elevated. Blood cultures, expectorate and bronchioalveolar lavage did not identify infectious agents. Enhanced chest computed tomography scan (Figure 1C) showed large, partially cavitated lesions, 8 cm in maximum diameter, involving the right lung, predominantly the upper lobe. No mediastinal lymph node enlargement was detected. The clinical condition improved on steroid treatment. | MATERIAL S AND ME THODSTUS-FNA of one of the cystic lesions was performed. Specifically, ultrasound convex transducers with a central hole for needle passage ( Figure 1A) allows TUS-FNA using a dedicated convex probe: this method allows real-time visualisation of the needle ( Figure 1B) and acquisition cytological samples for CB preparation (Figure 1D).A 4-mL sample of pinky, non-corpuscolated fluid sample ( Figure 1D) was obtained and processed as CB preparation. Calcium chloride and plasma solution at 1:1 was added to fluid sample obtained from TUS-FNA until a clot was formed and subsequently admixed with 10% buffered formalin. Finally, the solid clot was automatically processed and embedded in paraffin. CB sections were prepared and stained with haematoxylin and eosin.

Diagnosis of Hodgkin Lymphoma from Cell Block: A Reliable and Helpful Tool in “Selected” Diagnostic Practice

“…The two different methods (CCs and CBs) were compared using the Pearson Chi-square test or Fisher's exact test, when indicated, and p-values < 0.05 were considered statistically significant. Interestingly, among CB cases, one patient presented with clinical and radiological findings (pulmonary cystic lesions) which were tuberculosis-suspicious, but the final diagnosis was HL, classical type, as previously reported [15]. Fifteen patients' samples were sent to our attention with a clinical hypothesis of carcinoma.…”

“…We performed FISH analyses for c-Myc, BCL2 and BCL6 genes to subclassify diffuse large B-cell lymphoma on cases received after the 2017 WHO edition. Interestingly, among CB cases, one patient presented with clinical and radiological findings (pulmonary cystic lesions) which were tuberculosis-suspicious, but the final diagnosis was HL, classical type, as previously reported [15]. Fifteen patients' samples were sent to our attention with a clinical hypothesis of carcinoma.…”

“…Case number 24, previously described [ 15 ], was an 18-year-old woman with no previous oncological history, who presented to our Institute with a clinical-radiological diagnosis of tuberculosis. An enhanced chest CT scan showed large, partially cavitated lesions, 8 cm in maximum diameter, involving the right lung, without mediastinal lymph node enlargement.…”

EBV-Driven Lymphoproliferative Disorders and Lymphomas of the Gastrointestinal Tract: A Spectrum of Entities with a Common Denominator (Part 1)

“…Primary extra-nodal cHL represents a rare event (less than 1% of HL cases) [ 8 , 68 ]. Among the extra-nodal sites, the GIT is the most commonly involved.…”

Cutaneous Localization of Classic Hodgkin Lymphoma Associated with Mycosis Fungoides: Report of a Rare Event and Review of the Literature

“…Primary extra-nodal cHL represents an extremely uncommon event [4,5]. In cHL, cutaneous involvement is rare (<1%), represents an advanced disease stage, and is the result of direct, lymphatic, or hematogenous spread [6][7][8][9].…”