Primary pulmonary Hodgkin's lymphoma coexisting with extreme erythrocyte sedimentation rate.

Darko Katalinic, Ivan Aleric, Ivana Skrlec, Jasminka Talapko, Elke Kattner, Damir Tentor, Aleksandar Vcev
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Abstract

The paper aims to present the case of an asymptomatic 22-year-old man who was referred to the hematologist by laboratory experts primarily due to the extreme elevation of the erythrocyte sedimentation rate with a value of 197 mm/h. Additionally, moderate changes in laboratory parameters such as hemoglobin, leukocytes, lactate dehydrogenase, C-reactive protein, fibrinogen, and beta-2-microglobulin were recorded. Upon extensive clinical workup that included laboratory, imaging, and histological methods, a diagnosis of primary pulmonary Hodgkin's lymphoma (PPHL) was established. Primary pulmonary Hodgkin's lymphoma is a rare malignant lymphoproliferative disease that exclusively affects the lungs, and so far, only about 100 cases worldwide have been reported. The patient underwent first-line systemic chemotherapy with chest radiation and complete remission was obtained. Two years after completion of the treatment, a relapsed PPHL was clinically confirmed. Second-line chemotherapy followed by high-dose systemic chemotherapy with autologous hematopoietic stem-cell transplantation was indicated which led to complete remission and continues after 10 years from the initial diagnosis. The case demonstrates the important role of laboratory medicine experts who instantly suspected the possible laboratory-related tumor pathology and referred the patient to further hemato-oncological evaluation. This contributed to the timely diagnosis of PPHL, administration of appropriate treatment, and favorable outcome.

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原发性肺部霍奇金淋巴瘤并发极高红细胞沉降率。
本文旨在介绍一例无症状的 22 岁男性病例,该患者主要因红细胞沉降率极度升高(197 mm/h)而被实验室专家转诊至血液科。此外,血红蛋白、白细胞、乳酸脱氢酶、C 反应蛋白、纤维蛋白原和β-2-微球蛋白等实验室指标也出现了中度变化。经过包括实验室、影像学和组织学方法在内的大量临床检查,确定了原发性肺霍奇金淋巴瘤(PPHL)的诊断。原发性肺霍奇金淋巴瘤是一种罕见的恶性淋巴组织增生性疾病,仅累及肺部,迄今为止全球仅有约 100 例报道。患者接受了一线全身化疗和胸部放射治疗,病情得到完全缓解。治疗结束两年后,临床证实 PPHL 复发。患者接受了二线化疗,随后接受了大剂量全身化疗和自体造血干细胞移植,结果病情完全缓解,并在首次诊断后的10年后仍在继续。该病例显示了实验室医学专家的重要作用,他们即时怀疑可能存在与实验室相关的肿瘤病理,并将患者转诊至进一步的血液肿瘤学评估。这有助于及时诊断 PPHL,给予适当的治疗,并取得良好的疗效。
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