CRA35 A PAINFUL CLUE: FROM CERVICAL SPONDYLOSIS TO LUNG MASS- A DIAGNOSTIC ODYSSEY OF SECONDARY PULMONARY LYMPHOMA

Wai Leong Liew¹ Jun Wei Liew¹Yoke Fong Lam¹

¹Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia

Introduction
Secondary pulmonary lymphoma, a rare extranodal presentation of systemic lymphoma (12% Hodgkin Lymphoma, 4% non-Hodgkin lymphoma), often mimics common pulmonary or musculoskeletal conditions. Diagnosis is challenging due to nonspecific symptoms and overlapping radiological features.

Objective
To highlight the importance of comprehensive evaluation in young patients with atypical symptoms.

Methodology: Case Report
18-year-old previously well female presented with 6-month history of progressive neck pain and stiffness. She was diagnosed as cervical spondylosis based on X-ray findings of cervical kyphosis. At follow-up, she had worsening symptoms, requiring potent opioid analgesia. Outpatient magnetic resonance imaging (MRI) neck was arranged. Five months later, she complained of fever, productive cough, breathlessness, and weight loss (3kg over 2months). She was admitted and treated as lobar pneumonia. Laboratory findings showed leukocytosis (WBC 30.7 × 10⁹/L, neutrophils 79%), and chest X-ray showed left upper zone consolidation. She was discharged home and at clinic follow up, MRI neck showed soft tissue mass in left lung apex and mass over C1 vertebra with enlarged cervical, supraclavicular, and infraclavicular lymph nodes. Urgent CT thorax demonstrated a large left upper lobe lung mass (>9cm) encasing left pulmonary artery, with direct invasion into left breast's retroglandular region and medial aspect of pectoralis minor. Excisional biopsy of cervical lymph node was performed. Histopathology confirmed classical Hodgkin lymphoma, nodular sclerosis subtype. She was referred to hematologist.

Conclusion
This case highlights the need for careful assessment in young patients with atypical symptoms (neck pain). Not all lung consolidation is infectious; malignancy should be considered. Early imaging and biopsy are vital to prevent diagnostic delays and ensure appropriate treatment