Classical Hodgkin lymphoma (CHL) commonly arises in lymph nodes and initial presentation with extranodal disease is rare. We report a patient who presented with progressively worsening back pain, lower extremity weakness and numbness concerning for a myelopathic process of uncertain etiology. MRI revealed an epidural soft tissue mass with cord displacement, for which she underwent resection. Histological analysis of the surgical specimen demonstrated CHL. Further investigation revealed an anterior mediastinal mass, consistent with spread from a more typical location.
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