We present here a new case of the pulmonary lesion that developed in a 40-year-old Bosnian female previously diagnozed with Hodgkin disease. The diagnosis of HD was established in January 2006 based upon mediastinal and hilar lymphadenopathy. Subsequent chemotherapy for HD was induced.  
Now, on routine X ray, solitary lung lesion was detected. The lesion measured 2x1.7 cm. No signs of mediastinal lymphadenopathy.  
The lesion was surgically removed.  
Due to comparison we will set up the slides of both lesions (the first one diagnozed in 2006 and new one from the lung).  
The first lesion diagnozed as HD was composed of mixed cell types including lymphocytes, plasma cells, eosinophils and single, large mononuclear cells (lacunar cells). Single, Reed-Sternberg like cells were also seen (CD30+). Both morphological and immunohistochemical criteria fit the diagnosis of HD.  
Now, the patient developed multiple granuloma-like lesions in her lowe right lung lobe. Granulomas contained a lot of histocytes (CD68 diffusely positive), eosinophils, lymphocytes (pan-T, CD3+) and large, mononuclear, lacunar-like cells (negative for CD30 & CD15).  
Other IHQ: HMB45(-), SMA(-), CD20(-), S100(-), AE1/AE3 (stained only respiratory epithelium).  
Clinical diagnosis: No  
Histopathological diagnosis: Drug-induced pneumonitis, HD or?  
Please, give your opinion.

kunze 2007-08-30 12:58	The lung lesion is in my view reactive and shows similarities to an inflammatory pseudotumor. I'm not sure from your description: is it a solitary lesion or one of multiple lesions in the lower lobe of the right lung?
dalquen 2007-09-02 13:22	I agree with Prof. Kunze. Can you give us some images taken from an EvG-stained section? The exact lokalization of the lesion within the lobule and its relation to the vessels does not become clear from the H&E-stained sections.
semir 2007-09-05 16:25	EvG staining was performed and it stained a blood vessels without any evidence of their damage.
anpo 2007-09-08 23:30	Do you have a CD20 staining? EBV staining? a differential diagnosis could be lymphomatoid granulomatosis. The large CD30+ cells do not have RS cell morphology but may be B-cell immunoblasts.
kremer 2007-09-09 14:19	Absolutely, CD20 in my eyes is crucial, additionally EBV to rule out lymphomatoid granulomatosis, albeit angiodestruction is not really seen in the images. Inflammatory Myofibroblastic tumor could be an option (ALK-staining !)
nurija 2007-09-12 10:55	ALK,CD20,CD3,SMA,CD34 and EBV were performed. EBV was negative in the first and second biopsy
hurwitz 2007-09-30 16:12	I am not an expert on lungpathology, but Dr.Dalquen is. I think Dr.Kunzes and Dr.Dalquens diagnoses of an reactive lesion, in the lung can be accepted as final diagnosis.
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