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Chest CT scan at onset. A. Parenchymal lung involvement by pathologic tissue (Hodgkin's lymphoma). The pulmonary origin is demonstrated by the irregular margins of the lesion, especially evident in correspondence with the posterolateral portion (arrow). B. Intralesional bronchial structures (arrow). C. Window to the mediastinum. It is evident the "angiogram sign" (arrowhead) in the context of the parenchymal mass. Also here is evident an intralesional bronchial branch (arrow).
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No findings consistent with any pulmonary infiltrates or hilar and mediastinal lymph nodes involvement were detected (Figure 1).
Microscopic examination at diagnosis. Microscopic examination shows pulmonary tissue (A - indicated by a short arrow) with intra-parenchimal nodule of Hodgkin's Lymphoma (A - indicated by a thin arrow). At high magnification the nodule shows (C) many typical lacunar variant of Hodgkin's cells. Immunohistochemical analysis shows the expression of Surfactant Apoprotein-A in lung tissue (B) and staining of CD30 (D and d) and CD15 (E) antibodies in Hodgkin's cell surrounded by rosettes of CD3+ T lymphocytes (F).
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The microscopic examination (Figure 2) revealed lung tissue effaced by a nodular growth with thick collagen bands. These findings were consistent with a diagnosis of classic HL, nodular-sclerosis subtype grade 2 (Figure 2).