![]() ![]() The chest X-ray showed a left mediastinal enlargement (Figure 1).įigure 1. The neck ultrasound confirmed the presence of enlarged lymph nodes in the left supraclavicular side (2.4 × 1.3 cm) of the neck, with pathological aspects that were consistent with a lymphoproliferative disorder. The biochemical results showed increased ESR and CRP as well as a neutrophilic leukocytosis of approximately 13,000 leukocytes per microliter. An ultrasound exam of the neck and a chest X-ray were also prescribed. Subsequently laboratory test analysis were prescribed: complete blood count with differential, hepatic and renal function tests protein electrophoresis lactate dehydrogenase (LDH) serum electrolytes protein electrophoresis serology tests for Epstein-Barr virus (EBV), toxoplasmosis, HIV, and erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) inflammatory tests. The physical examination confirmed the presence of fixedlymph nodes of hard consistency in the left latero-cervical and supraclavicular area with an estimated size of 2.4 cm and without the evidence of any other superficial lymphadenopathy or organomegaly. The patient did not report any systemic symptoms including night sweats weight loss or fever. Her past and recent medical histories were fine and no other remarkable co-morbidities were reported. Her family history was unremarkable. In August 2015 an otherwise healthy 27-year-old female comes to the General Practitioner's office after experiencing flu-like symptoms with swelling on the left side supraclavicular region of the neck. Here the authors report a classical presentation of Hodgkin's disease in an otherwise healthy 27-year-old female. Hodgkin lymphoma is a potentially curable lymphoma. e) Patients may present with pruritus pain at sites of nodal disease, precipitated by drinking alcohol, occurs in fewer than 10% of patients but is specific for Hodgkin lymphoma Ī family history is also helpful in particular, nodular sclerosis Hodgkin lymphoma (NSHL) has a strong genetic component and has often been previously diagnosed in the family.d) Chest pain, cough, shortness of breath, or a combination of those may be present due to a large mediastinal mass or lung involvement.c) Intermittent fever is observed in approximately 35% of cases.b) Constitutional symptoms ( i.e., unexplained weight loss, unexplained fever, night sweats) are present in 40% of patients these are known as "B symptoms".a) Asymptomatic lymphadenopathy may be present (above the diaphragm in 80% of patients).Clinical presentation of Hodgkin lymphoma is the following: There are five types of Hodgkin lymphoma classified by the World Health Organization: nodular sclerosing, mixed cellularity, lymphocyte depleted, lymphocyte rich and nodular lymphocyte-predominant. The terminology recommended in the REAL classification was incorporated into the World Health Organization (WHO) classification of tumors of hematopoietic and lymphoid tissues, including the substitution of the term Hodgkin’s lymphoma for Hodgkin’s disease. CHL was further classified into 4 subtypes: nodular sclerosis CHL (NSCHL), mixed cellularity CHL (MCCHL), lymphocyte-rich CHL (LRCHL), and lymphocyte-depleted CHL (LDCHL). The Revised European American Lymphoma (REAL) classification in 1994 included Hodgkin’s lymphoma as one of the lymphoid neoplasms, and distinguished between 2 major types: nodular lymphocyte predominant Hodgkin’s lymphoma (NLPHL) and classical Hodgkin’s lymphoma (CHL). ![]() The modern classification of Hodgkin’s disease was introduced by Lukes and Butler. Hodgkin's lymphoma, nodular sclerosis CHL (NSCHL), asymptomatic lymphadenopathy Introduction The diagnosis of classical Hodgkin’s lymphoma, nodular sclerosis subtype, was made on a subsequent cervical lymph node biopsy. Subsequent Computed Tomography scan of the chest and abdomen confirmed the presence of many enlarged lymph nodes in the neck, mediastinum and liver, and a FDG-PET/CT scan showed multiple scattered consolidation lesions involving also the bones. An ultrasound of the neck detected many enlarged lymph nodes in the left supraclavicular region, and a chest X-ray showed left mediastinal enlargement. ![]() Herein, we report a case of classical Hodgkin’s lymphoma (HL) in an otherwise healthy 27- year-old female who came to the office of her general practitioner with flu-like illness and left supraclavicular swelling of uncertain nature, without other symptoms. ![]()
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