Phuong experienced coughing, fever, and sudden weight loss early last year. Initially diagnosed with a lung abscess, her condition didn't improve with medication. By the time she reached Tam Anh General Hospital in Hanoi, she had lost 26 kg – half her previous body weight – and was severely debilitated. A CT scan revealed lung lesions and abnormal lymph nodes, suggesting lung cancer or tuberculosis. Dr. Vu Huu Khiem, head of the oncology department, and his team decided to biopsy a lymph node in her chest to determine the cause.

Associate Professor Trinh Tuan Dung, director of the Center for Anatomic Pathology and Cell Biology at Tam Anh General Hospital, conducted specialized histopathological and immunohistochemical tests. These revealed Reed-Sternberg cells in Phuong's lymph nodes, positive for the CD15 and CD30 immunohistochemical markers. This confirmed a diagnosis of classical lymphocyte-predominant Hodgkin lymphoma, a cancer of the lymphatic system.

Associate Professor Dung reviews the histopathological and immunohistochemical test results. Photo: Tam Anh General Hospital

Associate Professor Dung reviews the histopathological and immunohistochemical test results. Photo: Tam Anh General Hospital

Associate Professor Dung explained that Hodgkin lymphoma in the lungs shares symptoms with other lung diseases, such as fever, cough, and uncontrolled weight loss, making misdiagnosis common. The disease has 4 subtypes. "Phuong's classical lymphocyte-predominant Hodgkin lymphoma is the most challenging to diagnose, easily missed because only about 1% of the cells are the diagnostic Reed-Sternberg cells, hidden among 99% normal cells," he said. In some cases, multiple biopsies and immunohistochemical tests are needed for a definitive diagnosis.

According to Dr. Khiem, early detection of Hodgkin lymphoma typically leads to a cure rate of over 90%. However, Phuong's case had progressed for a year before diagnosis, making standard chemotherapy regimens unsuitable.

She received personalized treatment starting with immunotherapy, combined with nutritional support to improve her physical condition and psychological counseling.

Phuong’s lung CT scan before treatment (left) and after six months (right). Photo: Hospital provided

Phuong’s lung CT scan before treatment (left) and after six months (right). Photo: Hospital provided

After 4 immunotherapy injections, Phuong's fever subsided, and she began to gain weight. After the 5th injection, she had gained 17 kg, reaching 48 kg. Her body mass index (BMI) improved from severely underweight to average. Dr. Khiem's clinical examination revealed that the lymph nodes in her neck and armpits had disappeared. A follow-up lung CT scan showed mostly fibrotic lesions, indicating good lung recovery. Having responded well to the immunotherapy, with no further fever or cough, Phuong transitioned to maintenance therapy.

Dr. Khiem checks on Phuong's health after treatment. Photo: Tam Anh General Hospital

Dr. Khiem checks on Phuong's health after treatment. Photo: Tam Anh General Hospital

Globocan recorded 613 new cases of Hodgkin lymphoma diagnosed in Vietnam in 2022. Dr. Khiem advises anyone experiencing fever, cough, and unexplained weight loss, especially those previously diagnosed with lung conditions that haven't responded to treatment, to consider Hodgkin lymphoma as a possibility.

Associate Professor Dung recommends that individuals with similar symptoms who have undergone biopsies for suspected Hodgkin lymphoma with negative results consider repeat biopsies and immunohistochemical testing to confirm the diagnosis and ensure timely treatment.

Thanh Long