Pulmonary Hodgkin Lymphoma in a Patient with Crohn’s Disease

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/ by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Classical Hodgkin lymphoma (HL) accounts for approximately 4.5% of all lymphomas in Korea. It is almost always a node-based lymphoma, and a primary extranodal manifestation of this disease is unusual. Interestingly, patients with a history of inflammatory bowel disease (IBD) who are treated with immu-nosuppressants have been noted to have an increased risk of lym-phoma; most cases that have been identified in this setting involve non-Hodgkin lymphoma (NHL). There have been few reported cases of primary intestinal HL in Crohn's disease (CD) patients, 1 and the development of extraintestinal HL in patients with CD has been reported even less frequently. 2,3 Herein, we describe a case of CD and small bowel obstruction complicated by the development of pulmonary HL in a 27-year-old man. A 27-year-old male was admitted to the emergency room with nausea, vomiting and diffuse abdominal pain. He had a long-standing history of CD (since 2009) and was being treated with prednisone (50 mg/day), mesalazine (1.5 g/day), and azathio-prine (50 mg/day). He received adalimumab (tumor necrosis factor-α [ TNF-α ] antagonist) twice (160 mg at week 0 and 80 mg at week 2) in order to control recurrent abdominal discomfort and diarrhea. Abdominal computed tomography (CT) and X-ray revealed a small bowel obstruction and a suspicious mass-like lesion in the right lower lobe of lung. Subsequent chest CT showed a mass approximately 3 cm in diameter in the right lower lobe (Fig. 1) and another two nodules in the right upper lobe with multiple lymphadenopathy in the mediastinum, neck, and supraclavicular areas. We performed segmental resection of the small bowel, wedge resection of the right lower lobe of lung, and mediastinal lymph node biopsy. The histopathologic findings of the lung showed a nodular growth pattern, separated by fibrous bands. The lymphoid nod-ule included scattered large atypical cells, resembling Hodgkin and Reed-Sternberg cells, in abundant reactive and inflamma-tory background including lymphocytes, plasma cells and his-tiocytes (Fig. 2B). The atypical large lymphoid cells were positive for CD30, CD15, and PAX5 (Fig. 2C, D), and negative for CD3 and CD20. These cells were negative for Epstein-Barr encoding region in situ hybridization. The histologic diagnosis, even conjunction with immunohistochemical stainings, was consistent with classical HL, …