A 22-year-old woman was admitted to our hospital complaining of productive
cough and
dyspnea even at rest, and marked cervical
lymphadenopathy. Marked
stridor and
orthopnea were observed, and auscultation of the chest revealed widespread expiratory wheeze which was not relieved by
bronchodilators administered intravenously. Chest X-ray and CT scan revealed hilar
lymphadenopathy and invasive
tumor of the mediastinum. Bronchoscopy demonstrated narrowing of the trachea anteriorly and posteriorly and a submucosal nodular
tumor protruding from the right anterior wall, causing approximately 90% occlusion of the lumen of the lower third of the trachea, but distal bronchi were intact. Microscopic findings of inguinal lymph node biopsy specimen revealed mixed cellular
lymphoma compatible with
Hodgkin's disease. Systemic
chemotherapy resulted in relief of symptoms, and two months later, the endotracheal
tumor had disappeared bronchoscopically, with slight residual
stenosis of the trachea. Before treatment, pulmonary function tests indicated markedly impaired forced volume in 1 second in both expiratory and inspiratory cycles, especially in the latter phase. After remission, however, obstructive ventilatory dysfunction was observed. The cause of prolonged air flow obstruction was thought to be marked infiltration and almost total involvement of the tracheal wall by
tumor with a nodular appearance of the lumen. Endotracheal
tumor in
Hodgkin's disease is rare, and there are few reports on pulmonary function associated with intrathoracic involvement of
malignant lymphoma.