PMC5036553_01
Pathology and immunohistochemistry.. Notes: (A) The arrow points to Hodgkin lymphoma cells expressing CD30. The image was obtained by staining CD30 when the disease was diagnosed in May 2012. (B) The arrow points to Hodgkin Reed-Sternberg cells surrounded by a large number of inflammatory and immune cells in an involved lymph node. The image was obtained from the initial involved lymph node. (C) The arrow points to the large cells expressing CD30 admixed with lymphocyte cells. These larger cells also expressed CD15, but we could not exclude the possibility of lung involvement. However, the patient exhibited classical B symptoms and experienced recurrence with incomplete remission. According to the PET/CT examination, the disease was classified as stage IV B lymphoma in September 2013. (D) After ASCT failure, the patient received six cycles of brentuximab vedotin treatment. However, the disease progressed after these therapies in April 2014. Then, through fiberoptic bronchoscopy lesion biopsy, the patient's multiple bilateral pulmonary lesions were diagnosed with involved classical Hodgkin lymphoma cells. Magnification (A and B) is 40x10 and (C and D) is 100x10.. Abbreviations: ASCT, autologous stem cell transplantation; CT, computed tomography; PET, positron emission tomography.
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A 54-year-old female was diagnosed with classical HL (Figure 1) involving her neck, mediastinal, and left hilus pulmonis lymph nodes corresponding to stage IIB (fever) in May 2012.
Response to therapy as shown on the PET/CT.. Notes: (A) The patient was diagnosed with classical Hodgkin lymphoma (HL) involving the neck, mediastinal and left hilus pulmonis lymph nodes in stage II B (fever) disease in May 2012. (B) After four cycles of ABVD, the neck and right hilus pulmonis lymph nodes faded. The mediastinal lymph nodes diminished but still appeared metabolically active in October 2012. Furthermore, the disease involved a new lesion. (C) After ASCT in May 2013, a partial response was achieved, and the mediastinal lymph nodes remained as residual lesions. (D) After the patient received ASCT and radiotherapy, the patient suffered again from fever and cough. The PET/CT demonstrated multifocal progressive disease involving primary and additional involved lymph nodes with increased metabolism of different levels compared with the previous PET/CT scan. The arrows indicate mediastinal and hilus pulmonis lymph nodes involved with Hodgkin lymphoma cells.. Abbreviations: ABVD, doxorubicin, bleomycin, vincristine, and dacarbazine; ASCT, autologous stem cell transplantation; CT, computed tomography; PET, positron emission tomography.
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According to the German Hodgkin Study Group classification system, the patient was considered to have advanced HL as the erythrocyte sedimentation rate was >30 mm/h with B symptoms and more than two regional lymph nodes were invaded, without extranodal involvement as assessed by positron emission tomography (PET)/computed tomography (CT) (Figure 2). Although the mediastinal lymph nodes had also diminished, PET/CT revealed that their metabolic activity had not decreased obviously or detectably (Figure 2).