The above case is being presented to highlight few peculiarities. Firstly, though a rare presentation, Hodgkin's lymphoma may involve the sternum and a differential for HL should always be kept in cases of osseous involvement. [ncbi.nlm.nih.gov]

• Mediastinal Lymphadenopathy

  Sometimes HL may present with mediastinal lymphadenopathy with or without superior vena cava obstruction.[11] Pleural effusion is seen 15-45% of cases depending on tumor staging and extra-nodal involvement.[12] Chylothorax[13] has also been reported in [ncbi.nlm.nih.gov]

• Cervical Lymphadenopathy

  Bone marrow involvement is seen in only 5-8% cases.[14] The above patient presented with sternal swelling, cervical lymphadenopathy, pleural effusion, hepatosplenomegaly and ascites. [ncbi.nlm.nih.gov]

• Splenomegaly

  Abdominal involvement includes lymphadenopathy, hepatomegaly, splenomegaly and ascites. [ncbi.nlm.nih.gov]

• Orthopnea

  She had progressive shortness of breath since 3 months which was accompanied by orthopnea. She also complained of loss of weight and appetite. [ncbi.nlm.nih.gov]

• Pleural Effusion

  Chest X ray revealed a left upper lobe heterogeneous lesion with cavitation and bilateral pleural effusion [Figure 1b]. [ncbi.nlm.nih.gov]

• Hepatosplenomegaly

  CT abdomen revealed hepatosplenomegaly, ascitis and enlarged lymph nodes in pre and para-aortic regions. [ncbi.nlm.nih.gov]

• Hepatomegaly

  Abdominal involvement includes lymphadenopathy, hepatomegaly, splenomegaly and ascites. [ncbi.nlm.nih.gov]

• Suggestibility

  The overall morphology of the lymph node was suggestive of mixed cellularity type of Hodgkin's lymphoma. Immunohistochemistry revealed staining with CD15 and CD30 suggestive of Hodgkin's lymphoma. [ncbi.nlm.nih.gov]

• Left Pleural Effusion

  Chest X ray revealed a left upper lobe heterogeneous lesion with cavitation and bilateral pleural effusion [Figure 1b]. [ncbi.nlm.nih.gov]

• Pleural Effusion

  Chest X ray revealed a left upper lobe heterogeneous lesion with cavitation and bilateral pleural effusion [Figure 1b]. [ncbi.nlm.nih.gov]

She presented to us with progressive dyspnea despite treatment. Physical examination revealed a sternal swelling and multiple enlarged cervical lymph nodes. [ncbi.nlm.nih.gov]

Moreover, she had B symptoms that included loss of weight, which explains her poor prognosis. The above case is being presented to highlight few peculiarities. [ncbi.nlm.nih.gov]