Incidence of Hodgkins lymphoma in the lung, an infrequent case of pulmonary infiltration without mediastinal lymphadenopathy



Year of publication 2003
Type Conference abstract
MU Faculty or unit

Faculty of Medicine

Description Background: We find that in a small group of patients especially with an advanced stage of Hodgkins lymphoma the condition spreads to the lungs. The finding of a lung infiltrate without existent mediastinal lymphadenopathy is extremely rare. The lung could be infected either by dissemination of tumorous tissue from adjacent (mediastinal or hilous) lymphnodes or we find multiple long distance noduli or masses. Aims: We will describe our experience with diagnosing and treating of patients with an advanced stage (clinical stage IIB with risk faktors, III, IV) of Hodgkins lymphoma, where we found lung involvement except for lymphadenopathy. We will draw attention to the case of a patient with general peripheric lymphadenopathy and conjoined lung infiltrate without mediastinal disease. Methods: The diagnosis of Hodgkins lymphoma was provided by a histological examination of a lymphnode. According to the CT scans was not the character of the lung infiltrates shawn to reguire surgery and the diagnoses were confirmed by disease regression appropriate therapy, except for the patient without mediastinal involvement (where a diagnostical minithoracotomy was indicated. Summary/conclusions: All patients with recent diagnosed Hodgkins lymphoma are now treated in our clinical department in accordance with the German study protocol German Hodgkins Lymphoma Study Group, managed by prof. Volker Diehl. The advanced stage patients are randomly distributed among the four arms of treatment in the study HD12 (arms A-D) and after said randomization treated with eight cycles of chemotherapy BEACOPP (escalated or basal) followed by radiotherapy in two of the four courses. We found lung infiltration only in 10 (45%) of 22 advanced stage patients, mostly characterized as a mass alveolar consolidation greater than 1cm (n=7) or nodules (n=3). Almost all patients displayed some of B symptoms (fever, weight loss, night sweats), but symptoms of lung disease were not always present. Of a total of 22 our patients 18 had been evaluated after completion of therapy up to this time (complete remission was achieved in 6 and completed remission with residuum in 12! patient). Cases of lung infiltration without proved mediastinal involvement by Hodgkins disease are extremely rare.

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