- 期刊
Hodgkin's Lymphoma Presenting as Pleural and Chest Wall Invasion: A Case Report
以肋膜和胸壁侵犯為表現的何杰金氏淋巴瘤：病例報告
摘要
何杰金氏淋巴瘤（Hodgkin’s lymphoma）是縱隔腔淋巴病變的原因之一，其擴散的方式常經由一個個鄰近的淋巴結散布出去。肋膜和胸壁的侵犯多半在縱隔腔淋巴病變已經相當巨大的情況下才會發生。我們報告一位41歲男性以胸痛表現求診。胸部X光發現一片邊緣不清的肺外病灶伴隨肋骨侵蝕。電腦斷層顯示局部肋膜增厚伴隨右側第6肋骨侵蝕、局部縱隔腔淋巴病變及左腋下單一淋巴結腫大。肋膜病理切片顯示非典型淋巴球浸潤，懷疑是何杰金氏淋巴瘤。腋下淋巴結切除後，病理報告確診為典型何杰金氏淋巴瘤。經過化學治療，肋膜病灶和淋巴病變均顯著縮小，正子攝影已看不出任何的惡性變化。在不明原因肋膜增厚的病患，病理學檢查是必須的診斷工具。
並列摘要
Hodgkin's lymphoma is not an uncommon cause of mediastinal lymphadenopathy. However, pleural and chest wall invasion are rare. Our patient, a 41-year-old male, presented to our clinic with recurrent right chest pain for 1 month. Physical exam was unremarkable, except a 1.5 cm, non-tender, soft lymph node was found at the left axilla. CXR revealed a faint extrapulmonary lesion at the right upper lung field with rib destruction. CT scan showed wide-based pleural thickening with adjacent right 6th rib destruction, some mediastinal lymphadenopathies, a T9 sclerotic lesion with adjacent enlarged soft tissue and a 1.5 cm left axillary lymphadenopathy. A pleural malignancy was suspected. CT-guided biopsy of the pleural lesion disclosed atypical lymphoid infiltrates, suspicious of Hodgkin's lymphoma. Excision biopsy of the left axillary lymph node revealed foci of large lymphoid cells with hyperchromatic nuclei and condensed cytoplasm. Binucleated Reed-Sternberg cells were present. A Hodgkin's lymphoma, classical-type, was diagnosed. After chemotherapy with an ABVD protocol, the CXR and CT scan both showed significant tumor regression. A PET scan did not disclose a viable hypermetabolic malignancy. Hodgkin's lymphoma usually spreads along with lymph node distribution. Pleural and chest wall involvement are rare. A detailed physical examination and tissue diagnosis are essential with the presence of any suspicious malignancy of pleural origin.