Hodgkin's disease masquerading as sclerosing mediastinitis

Cases in which fibrotic variants of Hodgkin's disease have been confused with sclerosing mediastinitis have rarely been reported. Sclerosing mediastinitis typically involves the superior/middle mediastinum and, in the United States, is most commonly due to histoplasmosis. We describe the case of a patient who came to us with fevers, a mixed anemia, and a posterior mediastinal mass that on pathologic examination appeared to be due to idiopathic sclerosing mediastinitis. Only inclusion of a biopsy specimen from a local celiac node, after a new porta hepatis mass was found, revealed the correct diagnosis of Hodgkin's disease of the nodular sclerosing type. With the correct diagnosis, early intervention and appropriate therapy resulted in clinical cure.