Orderly contiguous spread from mediastinal (involved in 66% of Hodgkin’s cases) nodes -> hilar nodes -> lung parenchyma (involved in >10% of cases: almost always associated with mediastinal node involvement)
Bulky mediastinal disease (tumor: thoracic diameter ratio >0.3): associated with spread to pleura/ pericardium/ chest wall (spread probably requires bulky mediastinal nodes)
Pathology
Nodular sclerosing type is present in 67-84% of cases with thoracic Hodgkin’
Diagnosis
Sputum cyto: may reveal Reed-Sternberg cells
FOB: may reveal Reed-Sternberg cells by BAL/ EBB/ TBB
FNA: cyto is useful to diagnose lung lesions in most cases
OLB: may be necessary
CXR/Chest CT Pattern:
Mediastinal adenopathy: present in almost all cases with parenchymal lung involvement
Linear interstitial infiltrates and/ or small nodules: due to contiguous spread to lung
Clinical
B symptoms: fever/ night sweats/ weight loss
Lesions near airway: obstructive symptoms
Treatment
Treatment is stage dependent
Bulky mediastinal disease: chemo or chemo + XRT
Nodular/interstitial lung involvement: need to treat with chemo or XRT involving affected lung area
Complications of treatment: NHL, sarcoma, lung ca. occurring in irradiated field (may occur years later)
Post-treatment recurrence (to lungs): predisposed by advanced stage disease at diagnosis (especially with B symptoms)/ bulky mediastinal nodes/ inadequate initial staging or treatment
For XRT-treated cases: recurrence occurs at edge of mantle field of XRT or diffusely in lungs
For chemo-treated cases: recurrence at prior nodal sites (especially bulky mediastinal nodes) or extension into lung
Prognosis
Controversial if lung involvement portends worse prognosis
