Bulky mediastinal classical Hodgkin lymphoma in young women.

In 2013, an estimated 9,290 cases of Hodgkin lymphoma (HL) were diagnosed in the United States, and 1,180 patients died from their disease. The median age at diagnosis is 38 years, although there is a bimodal age distribution with peaks around ages 20 and 65.[1] Mediastinal involvement is present in 60% of patients at diagnosis, and bulky mediastinal disease is seen in 20% to 25% of clinical stage I–II patients.[2] The definition of bulk has evolved as imaging modalities have changed. The most common one is based on results of a chest X-ray, and bulky disease (denoted by the letter “X”) is defined based on the ratio of the maximum width of the mediastinal mass and the maximum intrathoracic diameter on standing posterior-anterior X-ray (mediastinal mass ratio [MMR] > 0.33).[3,4] Other reports use a ratio with intrathoracic width at T5–T6.[5] Using CT, bulk is defined as a mass larger than 10 cm.[6] Studies suggest that chest X-ray findings correlate with the results of newer imaging modalities in approximately 90% of patients.[7]