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Histological examination. (A & B) Hodgkin/Reed-Sternberg cells seen in a reactive background of a lymph node tissue (H&E x40). (C & D) Immunohistochemical study demonstrates that Reed-Sternberg cells are positive for CD30 and CD15. (E) Reed-Sternberg cells are positive for EBV (LMP-1).
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There were many large atypical cells consistent with Hodgkin/Reed-Sternberg cells and mummified cells seen in the reactive background (Fig. 1A and B). EBV (LMP-1) antibody test showed that it was positive in Hodgkin/Reed-Sternberg cells (Fig. 1C-E).
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Bone marrow aspirate showing involvement by monotonous population of leukaemic cells deeply basophilic cytoplasm with prominent vacuolation. Insert (bottom left) shows a mitotic figure (Wright stain x 1,000).
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The BM aspirate smear unexpectedly showed infiltration with monotonous population of leukemic cells (~27%), medium size with regular round nuclei, dispersed nuclear chromatin, deeply basophilic cytoplasm with prominent vacuolation (Fig. 2).
Bone marrow biopsy monotonous lymphoid population of intermediate sized cells with multiple small nucleoli and increased mitotic figures (A; H&E x500). Immunostains on bone marrow biopsy: the lymphoma cells are positive for CD20 (B; 500), CD10 (C; 100), cMYC (D; x100), EBER (E) and KI-67 (F; x100).
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BM biopsy was hypercellular and showed abnormal interstitial infiltrates by monotonous lymphoid population of intermediate-sized cells with multiple small nucleoli and increased mitotic figures (Fig. 3A). By immunohistochemical stains, the neoplastic cells were positive for CD20, CD79, CD10, BCL-6, c-MYC, and EBV ribonucleic acid (RNA; using in situ hybridization technique; Fig. 3B-E). Ki-67 proliferation index is more than 95% of neoplastic cells (Fig. 3F).
Positron Emission Tomography/Computed Tomography (PET-CT). (A) Images at diagnosis shows multiple affected lymph nodes, multiple liver, spleen and skeletal muscle lymphomatous lesions, multiple pleural, peritoneal, extensive gastric and sporadic bowel involvement, multiple bone involvement and bilateral breast involvement. (B) PET CT scan after two cycles of chemotherapy showed complete metabolic remission.
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PET-CT showed complete metabolic remission (Fig. 4B).
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Positron Emission Tomography/Computed Tomography (PET-CT). (A) Images at diagnosis shows multiple affected lymph nodes, multiple liver, spleen and skeletal muscle lymphomatous lesions, multiple pleural, peritoneal, extensive gastric and sporadic bowel involvement, multiple bone involvement and bilateral breast involvement. (B) PET CT scan after two cycles of chemotherapy showed complete metabolic remission.
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PET-CT showed complete metabolic remission (Fig. 4B).
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