case_images: PMC6477491_01
case_images: A - Surgical biopsy demonstrates: fusiform cells proliferation, arranged in curved bundles, sometimes in a whirl pattern, between which there was founded an important number of foamy histiocytes, plasmocytes, and multinucleate cells. B - Second biopsy, it is observed, in the sample, atypical big lymphocytes. C - Second biopsy, it is observed, in the sample, positive CD30.
case_images: cro-0012-0119-g01.jpg
case_images: PMC6477491_01_cro-0012-0119-g01.jpg
case_images: F1
case_images: The contrasted chest magnetic resonance evidenced an expansive lesion of infiltrative pattern in the retrosternal region, reaching the soft parts and the intercostal muscles between the first and the fourth right costal cartilages (Fig. 1). ABVD protocol, in four cycles in tandem with the radiotherapy. After treatment, the patient made a PET-scan for control that resulted in the complete resolution of the expansive lesion in the thorax and a mediastinal lymphadenomegaly (Fig. 1).
case_images: A - Firth contrasted chest magnetic resonance evidenced an expansive lesion of infiltrative pattern in the retrosternal region, reaching the soft parts and the intercostal muscles between the first and the fourth right costal cartilages. There wasn't a cleavage plane between the lesion and the pectorals major muscle. B - Computerised tomography with protons emission - PET/CT-scan - revealed retrosternal expansive lesion, poorly defined and with an heterogeneous metabolism increasing, that extends from the first to the fourth right costal arches and involves the region of the right internal mammary and the right cardiophrenic region, presenting an increased metabolism (SUV = 3, 8) and mediastinal lymphadenomegaly, presenting an increased metabolism in the upper and lower paratracheal region (SUV = 19, 9). C - Control computerised tomography with protons emission - PET/CT-scan that resulted with the complete resolution of the expansive lesion in the thorax and a mediastinal lymphadenomegaly.
case_images: cro-0012-0119-g02.jpg
case_images: PMC6477491_01_cro-0012-0119-g02.jpg
case_images: F2
case_images: Histological samples also revealed fusiform cells proliferation, arranged in curved bundles, sometimes in a whirl pattern, between which there was founded an important number of foamy histiocytes, plasmocytes and multinucleate cells (Fig. 2). There were also observed, in the sample, atypical big lymphocytes, and positive CD30 (Fig. 2), following the immunohistochemistry panel (Table 1), suggesting the hypothesis of the Classical Hodgkin lymphoma, nodular sclerosis subtype.