Primary pulmonary Hodgkin's lymphoma: A rare pitfall in transthoracic fine needle aspiration cytology

Abstract

Primary pulmonary Hodgkin's lymphoma (PPHL) is extremely rare. At an extranodal location such as the lung this lymphoma is likely to be confused with the more commonly occurring carcinomas at this site. We report the fine needle aspiration cytology (FNAC) findings of a PPHL in a 36-year-old male with a view to discuss the pitfalls and clues to the accurate cytologic diagnosis. This patient presented with a large, heterogeneously enhancing mass involving the anterior segment of right upper lobe without any evidence of nodal involvement. A CT-guided transthoracic FNAC of this mass revealed large connective tissue fragments with entrapped voluminous cells amidst a polymorphous population of eosinophils, polymorphs, and lymphocytes. The large cells showed abundant often stripped off cytoplasm, an irregular nucleus with nucleolus and were initially diagnosed as non-small cell carcinoma of the lung. In view of the locally advanced stage, patient received a carboplatin and gemcite-based chemotherapy with complete response but postchemotherapy patient refused local surgery. Two years later, the patient developed enlarged nodes which were diagnosed as Hodgkin's lymphoma, and a review of prior lung tumor confirmed the diagnosis of PPHL. Hence the rare diagnosis of PPHL should be kept in mind when a cytopathologist observes large cells embedded in collagenous tissue fragments with dominant cell dispersal amidst an inflammatory infiltrate in an aspirate from a primary lung tumor.

Fine‐needle aspiration of extranodal Hodgkin's lymphoma misinterpreted as carcinoma

“…This case and the recent report by Kumar et al 1 are reminders not only of the cytomorphological similarities between RS cells/variants and carcinoma cells but also of the importance of the characteristic cellular ''milieu'' in establishing a correct diagnosis of HL. HL should be included in the differential of smears composed of large bare atypical nuclei with large nucleoli.…”

Giant thoracic mass: an unusual presentation of primary pulmonary Hodgkin's lymphoma

“…An intraoperative biopsy should be considered when major lung resection (lobectomy or pneumonectomy) will be required for removal, which was not the case with this patient. One previous case report has alluded to the difficulty in obtaining an accurate diagnosis in PPHL with CT-guided biopsy, with the patient being diagnosed with non-small-cell lung cancer 5. The case we present demonstrates that a negative preoperative biopsy does not exclude the diagnosis of PPHL.…”

Primary pulmonary Hodgkin Lymphoma simulating a mediastinal tumour: an uncommon occurrence.

“…With this regard, our experience outlined the diagnostic role of VATS,7 suggesting our experience that the use of frozen section and the thoracoscopic approach should guide the surgeon to obtain a representative biopsy of the lesion in order to perform both an optimal paraffin histology and immunohistochemical studies, allowing an appropriate differential diagnosis. With this regard, differential diagnosis between PPHL and other thoracic diseases associated with mediastinal enlargements7–10 may troublesome and includes infectious and non-infectious granulomatous diseases, reparative phenomena and solid tumours. Granulomatous inflammation, when associated with HL, can be similar to other granulomatous lesions, such as Wegener granulomatosis and mycobacterial and fungal infections.…”