PMC4950766_01
Imaging findings at disease presentation and progression. a CT abdomen and pelvis with contrast showing an enlarged spleen with micronodular pattern. b PET-CT imaging showing interval resolution of splenomegaly and documenting no evidence of hypermetabolic adenopathy. c Repeat CT chest with contrast evidencing development of a right axillary node measuring 2.9 x 2.4 cm and a left axillary node measuring 3 x 1.5 cm (white arrows). d Repeat CT abdomen and pelvis evidencing again an enlarged spleen with numerous small subtle hypodense nodules
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Fig1
Initial computed tomography (CT) scan of the abdomen and pelvis during hospital admission showed a 15 cm spleen which was heterogenous and micronodular, as well as scattered abdominal and pelvic lymphadenopathy (Fig. 1a). Our patient presented 7 weeks later at the emergency room with a recurrent febrile syndrome with diffuse cervical and axillary lymphadenopathy and splenomegaly (Fig. 1c-d) and worsening cytopenias: WBC 1800/uL, ANC 1480/uL, Hgb 8.3 gr/dL, platelet count 20,000/uL; a repeat EBV titer revealed 6580 copies/mL. Low volume retroperitoneal and pelvic lymphadenopathy, hepatosplenomegaly with numerous small ill-defined hypodense lesions was in the spleen and probably also within the liver (Fig. 1d).
Bone marrow histopathologic findings confirming diagnosis of Hodgkin lymphoma. a Bone marrow biopsy demonstrated involvement by classical Hodgkin lymphoma. Neoplastic large lymphoid cells with Hodgkin-Reed-Sternberg morphology were present in a background rich in histiocytes, small lymphocytes, and plasma cells. b The neoplastic cells were positive for CD30. The neoplastic cells were also positive for the B-cell marker PAX5 by immunohistochemistry (not shown). c Colorimetric in situ hybridization was positive for Epstein-Barr virus-encoded RNA within the neoplastic cells (blue signal)
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Fig2
The findings were diagnostic of classical Hodgkin lymphoma, best subtyped as lymphocyte-depleted. (Fig. 2a-c).