A clinical case of atypical course and difficulties in diagnosing Hodgkin's lymphoma

Hodgkin's lymphoma (LH) is a B-cell malignant lymphoproliferative disease. There are no specific symptoms characteristic only for this disease. Here may be an asymptomatic increase in peripheral lymph nodes; symptoms of intoxication (B-symptoms — fever above 38 ° C for at least three consecutive days without signs of inflammation; night profuse sweats; weight loss by 10% of body weight over the past 6 months); intermittent fever; itching; in patients with massive mediastinal lesion — chest pain, cough, shortness of breath, symptoms of compression of the superior vena cava, with localization closer to the sternum, discomfort behind the sternum is possible. The presence of the formation of mediastenia and purulent process (abscess, phlegmons, osteomyelitis), resistant to surgery (autopsy, drainage, resection) and antibacterial therapy requires the exclusion of the neoplastic process. It is necessary to carefully observe the technique of performing biopsy and transporting material in a neutral formalin solution at an early date to the pathological - anatomical laboratory, in case of non-standard manifestations of the disease, revision of the biopsy material with mandatory immunohistochemical examination. It is important to bear in mind that the presence of comorbidity (obesity, hypertension, diabetes mellitus) creates additional objective difficulties in the diagnosis and treatment, and requires a collegial decision by a consultation of specialists in patient management tactics.

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