Approximately half of all mediastinal lesions are asymptomatic and are detected on chest radiographs taken for unrelated reasons. The absence of symptoms suggests that a lesion is (maybe) benign, whereas the presence of symptoms suggests malignancy. In adults, 48-62% of lesions are symptomatic, whereas the percentage of symptomatic lesions is higher in children (58 to 78%). The most common symptoms are cardio respiratory - in particular, chest pain and cough. Other manifestations are heaviness in the chest, dyspnea, signs of superior venacaval obstruction with facial swelling, and cyanosis. Recurrent respiratory infections are also common. Cutaneous paraneoplastic manifestations in Hodgkin Lymphoma (HL) have been well described. These include eczema, prurigo, mycosis fungoidosis and erythema nodosum. Pruritus is a well-recognized presenting symptom of Hodgkin lymphoma.