Abstract Introduction The coexistence of benign and malignant airway lesions is rare and diagnostically challenging, particularly when clinical findings can be attributed to a single dominant process. Hodgkin’s lymphoma commonly presents with mediastinal lymphadenopathy and systemic symptoms, whereas endobronchial squamous papilloma (ESP) is a benign epithelial lesion typically linked to human papillomavirus (HPV) infection. This case highlights the importance of comprehensive evaluation and avoiding diagnostic anchoring when multiple pathologies may coexist. Case Presentation An 18-year-old female with no significant past medical history presented with progressive shortness of breath and recurrent episodes of pneumonia that failed multiple courses of antibiotics. Chest CT revealed diffuse mediastinal and hilar lymphadenopathy, raising concern for a malignant process.Flexible bronchoscopy was performed for further evaluation. During inspection, multiple small endobronchial lesions were noted throughout the tracheobronchial tree. Endobronchial and transbronchial biopsies were obtained. Histopathologic examination of the mediastinal lymph node revealed classic Hodgkin’s lymphoma. Unexpectedly, one of the endobronchial lesions demonstrated squamous papilloma with mild squamous dysplasia. The patient was referred to oncology and initiated on standard chemotherapy for Hodgkin’s lymphoma. Given the benign but potentially premalignant nature of squamous papilloma, the multidisciplinary team—including oncology, pulmonology, and thoracic surgery—opted for close surveillance. A repeat bronchoscopy was scheduled six months post-chemotherapy to reassess the persistence or progression of endobronchial lesions. Discussion Endobronchial squamous papilloma is an uncommon benign tumor that can arise anywhere along the respiratory tract. While often incidental, ESP may present with cough, hemoptysis, or airway obstruction. Histologic variants with dysplasia may carry malignant potential. Hodgkin’s lymphoma, on the other hand, can cause compressive airway symptoms due to mediastinal lymphadenopathy, potentially masking concurrent airway lesions.This case underscores two key lessons: first, not all airway abnormalities in oncology patients are secondary to the primary malignancy; and second, broad diagnostic sampling during bronchoscopy can uncover coexisting pathologies that alter management. The coexistence of Hodgkin’s lymphoma and endobronchial squamous papilloma is exceedingly rare, and awareness of such overlap can prevent misdiagnosis or delayed recognition of secondary airway disease. Comprehensive airway evaluation remains essential in patients with complex respiratory findings, even when a unifying diagnosis seems apparent. This abstract is funded by: N/A
Joseph et al. (Fri,) studied this question.