The Terrible Lymphoma

Today in morning report we discussed a young patient who presented with pre-syncope.
The patient was otherwise well, but as part of the workup had a CXR that revealed an anterior mediastinal mass.

DDx of anterior mediastinal mass, 
brought to you by the letter "T"

Thymoma
Teratoma
Thyroid
Terrible Lymphoma
...and if lung parenchymal involvment, think of lung cancer

CT confirmed the mass with neck and supraclavicular lymphadenopathy.
No other involvement. 

Core biopsies were done and pathology showed Reed-Sternberg cells pathognomic for Hodgkin's Lymphoma. Remember an FNA is not enough, need core or excisional biopsy.

Staging was Stage IIA as per the Ann Arbor Staging:
I: one lymph node group
II: > one, same side of diaphragm
III: both sides of diaphragm
IV: extranodal involvement eg. bone marrow

All patients with lymphoma should be checked for HIV, Hep B and Hep C.


Hodgkin's Lymphoma is curable, has a bimodal age distribtuion.

Treatment regimens include ABVD chemotherapy, radiation for limited stage.

From an internist's perspective, important to know the cardiotoxicity of adriamycin, with cumulative dose being the biggest risk factor. This patient had a MUGA scan prior to starting therapy.

Also, bleiomycin can cause pulmonary fibrosis, and we discussed the interesting point that for some patient groups e.g. professional athletes, perhaps this side effect may dissuade them from including in their treatment regimen (famous examples in the past).

Fertility issues also need to be addressed prior to treatment.

Click here for a review on Hodgkin's Lymphoma from the Lancet.