The Cystic Appearance of a Mediastinal Mass Does Not Exclude Lymphoma: A Case Example of Classic Hodgkin Lymphoma in a Thymic Cyst and a Brief Literature Review

Samir Kahwash; Sheridan Chaves; Ashlie Patton

doi:10.1055/s-0044-1785529

Ibnosina Journal of Medicine and Biomedical Sciences, Table of Contents

CC BY-NC-ND 4.0 · Ibnosina Journal of Medicine and Biomedical Sciences 2024; 16(03): 126-130
DOI: 10.1055/s-0044-1785529

Case Report

The Cystic Appearance of a Mediastinal Mass Does Not Exclude Lymphoma: A Case Example of Classic Hodgkin Lymphoma in a Thymic Cyst and a Brief Literature Review

Samir Kahwash

¹Department of Pathology and Laboratory Medicine, Nationwide Childrens Hospital, Columbus, Ohio, United States

,

Sheridan Chaves

¹Department of Pathology and Laboratory Medicine, Nationwide Childrens Hospital, Columbus, Ohio, United States

,

Ashlie Patton

¹Department of Pathology and Laboratory Medicine, Nationwide Childrens Hospital, Columbus, Ohio, United States

› Author Affiliations

Abstract

Herein, we report a case of a 16-year-old girl who presented with an episode of shortness of breath while playing sports. Upon radiologic workup, she was found to have a large multicystic anterior mediastinal mass. The cystic appearance of mass and lack of constitutional symptoms contributed to favoring a benign cystic process and deferring surgical resection until the end of sport season. When surgery was performed 3 months later, microscopic examination showed findings diagnostic of classic Hodgkin lymphoma arising in a thymic cyst. Despite the rarity of such cases, it is important to remember that the cystic nature of an anterior mediastinal mass does not exclude lymphoma. Definitive diagnosis is not possible without examination of representative tissue.

Keywords

anterior mediastinal - cystic thymic masses - Hodgkin lymphoma - mediastinal mass - Reed–Sternberg cells

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References

References
1 Goldblum JR, Lamps LW, McKenney JK. et al. Eds. Rosai and Ackerman's Surgical Pathology. Eleventh edition. Cambridge, MA: Elsevier; 2018
2 Bhunia N, Ondrejka S, Flagg A. et al Classical Hodgkin lymphoma of cystic thymus in a patient with infectious mononucleosis: diagnostic challenges and practical considerations. Pediatric Hematology Oncology Journal. 2021; 6 (02) 81-83
3 Steinmüller F, Traeger T, Kühn JP. et al Rare case of a large mediastinal cyst involved in Hodgkin's lymphoma. Pathol Res Pract 2012; 208 (05) 306-309
4 Almarzooqi S, Hammond S, Kahwash SB. Hodgkin lymphoma in a thymic cyst: report of a case with multiple secondary neoplasms. Case Rep Med 2010; 2010: 795037
5 Kocaman G, Özakıncı H, Yüksel S. et al. Three in one: a case presented with multiloculated thymic cyst, thymic Hodgkin lymphoma and pericardial cyst. Turk Gogus Kalp Damar Cerrahisi Derg 2023; 31 (02) 289-294
6 Lewis CR, Manoharan A. Benign thymic cysts in Hodgkin's disease: report of a case and review of published cases. Thorax 1987; 42 (08) 633-634
7 Whitten CR, Khan S, Munneke GJ. et al A diagnostic approach to mediastinal abnormalities. Radiographics 2007; 27 (03) 657-671
8 Çinar HG, Gulmez AO, Üner Ç. et al Mediastinal lesions in children. World J Clin Cases 2023; 11 (12) 2637-2656
9 Kahn JM, Pei Q, Friedman DL. et al. Survival by age in paediatric and adolescent patients with Hodgkin lymphoma: a retrospective pooled analysis of children's oncology group trials. Lancet Haematol 2022; 9 (01) e49-e57
10 Suster S, Rosai J. Multilocular thymic cyst: an acquired reactive process. Study of 18 cases. Am J Surg Pathol 1991; 15 (04) 388-398
11 Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 47-1982. Persistence of a mediastinal mass after chemotherapy for Hodgkin's disease. N Engl J Med 1982; 307 (22) 1391-1397
12 Kim HC, Nosher J, Haas A. et al Cystic degeneration of thymic Hodgkin's disease following radiation therapy. Cancer 1985; 55 (02) 354-356
13 Lindfors KK, Meyer JE, Dedrick CG. et al Thymic cysts in mediastinal Hodgkin disease. Radiology 1985; 156 (01) 37-41