Age/Sex: 27/M Chief complaints: night sweat, mild fever, weight loss for last two months Diagnosis: Hodgkin Disease (nodular scl...
Age/Sex: 27/M
Chief complaints: night sweat, mild fever, weight loss for last two months
Diagnosis: Hodgkin Disease (nodular sclerosing type)
Brief discussion:
Patients with anterior mediastinal mass pose a diagnostic challenge. Differential diagnoses include lymphoma, thymic neoplasms, substernal thyroid mass, germ cell tumors, and, mediastinal tuberculous lymphadenopathy should be included. Hopper et al. reported that necrotic, cystic-appearing mediastinal lymph nodes are a common finding in newly diagnosed Hodgkin disease, occuring in 21% of cases. Necrosis is common in the more sclerotic forms of Hodgkin disease. These necrotic areas range from minute foci of fibrinoid necrosis to large areas of granular tissue destruction containing necrotic cells. Necrosis is seen most commonly in the nodular sclerosing and mixed celluarity cell types of lymphoma and is not seen in the lymphocyte predominant variety. Nodal necrosis is most extensive in the nodular sclerosing variety. This cystic appearance of mediastinal adenopathy in the patients with Hodgkin disease does not affect overall survival or length of remission. Hodgkin disease involve anterior mediastinum or paratracheal regions in 90%-100% of cases, but confined to the anterior mediastinum in approximately 40% of cases. Superior mediastinum is almost invariably involved. Hodgkin disease spreads from the anterior mediastinal/paratracheal area in a contiguous manner. On the other hand, there is the overwhelming preponderance of tuberculous mediastinal lymphadenitis(that is a major differential diagnosis in this case) in the right tracheobronchial and paratracheal area.
