A 26-year-old man presented with a 3-month history of chest pain, facial swelling, lumps within his axillae, and weight loss. Examination confirmed right axillary lymphadenopathy and early signs of superior vena caval obstruction. He had no significant medical or family history. 

The patient denied cigarette smoking; however, smoked large quantities of cannabis. He began smoking cannabis at the age of 14 years, initially one to two joints daily. Between the ages of 18 and 24 years, his cannabis consumption increased to eight joints daily.