The two distinct branches of Hodgkin lymphoma are nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) and classical Hodgkin lymphoma (CHL). While NLPHL occurs primarily in males within the 30- to 50-year age group, CHL has a bimodal age distribution with the first peak occurring at 15 to 35 years of age and the second peak occurring around the seventh decade of life. There is a slight male predominance in CHL. A common presenting complaint is peripheral lymphadenopathy, although the nodular sclerosis subtype of CHL is often associated with mediastinal involvement as well. B symptoms, including fever, drenching night sweats, and significant weight loss, are seen in up to 40% of patients.¹

Secondary pulmonary involvement, typically presenting as an extension of disease originating in mediastinal and hilar lymph nodes, has been shown to occur in 6% to 12% of patients and is usually the classic nodular sclerosing type.¹ Multinodular involvement of the lung is uncommon and indicative of stage IV disease.

Primary pulmonary Hodgkin lymphoma (PPHL) is rare and is thought to arise directly from lung-associated lymphoid tissue.² Common presenting symptoms included dry cough, fever, or chest pain.³ Due to the nonspecific nature of these symptoms, a delay in diagnosis and treatment may occur.^3,4 Most cases are classical nodular sclerosing type,^2,3,5,6,7,8 with a few cases of mixed cellularity; other subtypes have not been described as primary in the lung.⁴