Reed-sternberg cells in bronchial brushings from a patient with Hodgkin's disease

Abstract

A 59-yr-old male with stage IV Hodgkin's lymphoma of nodular sclerosing type was admitted to our institution approximately 9 mo after initial diagnosis with complaints of fever, chills, and fatigue. The patient had recently completed a cycle of multidrug chemotherapy. Laboratory data upon admission demonstrated leukocytosis with neutrophilia and mild anemia, and a chest X-ray illustrated right upper lobe and left midlung opacities. A bronchoscopy with cytologic brushings was subsequently performed.Cytologic analysis demonstrated isolated large mononucleated variants of Reed-Sternberg cells, some of which were bilobed (Fig. 1). This unexpected finding prompted a follow-up CT-guided FNA of the left upper midlung lesion, which further supported the diagnosis of Hodgkin's disease (HD).Pulmonary involvement occurring in the course of HD is common. Clinical studies suggest that HD involves the lung in approximately 40% of patients and usually represents an extension of disease originating in the mediastinum, 1 although rare cases of primary pulmonary HD have been described. 2,3 It has been reported previously that, of the various subtypes of HD, the nodular sclerosing variety is most often associated with pulmonary parenchymal involvement as seen by radiography. 4 The development of lung lesions seen on X-ray in a patient with HD presents the clinician with a diagnostic problem, since radiologic features of pulmonary HD are variable and nonspecific and may resemble opportunistic pulmonary infections or lung abnormalities induced by chemotherapy or radiotherapy. In this situation, the prognostic and therapeutic implications of establishing a correct diagnosis are of great importance. Cytology of sputum or bronchial washings/brushings may reveal diagnostic Reed-Sternberg cells and establish the diagnosis of pulmonary HD, obviating the need for more aggressive surgical procedures.

Primary pulmonary Hodgkin's lymphoma and a review of the literature since 2006

“…In PPHL, the nodular sclerosing histological type is most common, as was our case, followed by the mixed cellularity type 7 21 22. Initial misdiagnosis based on histological appearance, as occurred in the present case, has been reported previously 23 24.…”

Primary Pulmonary Hodgkin’s Lymphoma

“…Nodular sclerosis of the Hodgkin's disease variety is the most frequent histological subtype found in the PPHL presentation, which occurs more frequently in women than in men. The mixed cellularity subtype has also been described (6,11,12).…”

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

“…Although sputum cytology and bronchoalveolar lavage have been reported as useful techniques for diagnosing pulmonary involvement in HL, they yield diagnostic results only when there is an intraluminal growth or mucosal ulceration. [16][17][18][19][20] If the RS cells are identified they may be interpreted as reactive pneumocytes or bronchiolar epithelial cells and sometimes even as large cell carcinoma or melanoma given their large atypical nuclei. 6 However, the presence of a polymorphous background, large connective tissue fragments with entrapped large nucleolated (RS) cells with discohesion, and apoptosis help in the correct diagnosis.…”