PMC7506053_01
Tumor in the lateral part of the left temporal lobe and the cerebellum in magnetic resonance imaging (MRI) scans.
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F1
The magnetic resonance imaging (MRI) scans of the head revealed the tumor present in the lateral part of the left temporal lobe and the cerebellum (Figure 1).
Necrotic area of the lung surrounded by atypical lymphoid cells (A,B); dense lymphocytic infiltration of the wall of the blood vessel (C); and positive immunostaining for CD20 (D), CD30 (E), and EBV/LMP1 (F) corresponding to grade 1 lymphomatoid granulomatosis (magnification A-10x; B,D-F-20x; C-40x).
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F2
However, on further evaluation of the formalin-fixed paraffin-embedded sections, we observed many irregular necrotic areas, as well as fibrinous exudate with many macrophages and a few neutrophils in the alveoli (Figures 2A-C). T cells (CD3+) were found (Figures 2D-F). The final diagnosis was changed to grade 1 LYG with lung involvement.
Dense infiltration of the brain composed of Reed-Sternberg cells, small lymphocytes, and macrophages (A-C) corresponding to the classical Hodgkin lymphoma of the central nervous system, mixed cellularity (MCcHL), and positive immunostaining for CD30 (D), CD20 (E), and EBV/LMP1 (F) in Reed-Sternberg cells (objective magnification A-10x; B,C-40x; D-F-20x).
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F3
T cells (CD3+) and macrophages (CD68+) with dispersed giant cells of Reed-Sternberg morphology were observed (Figures 3A-C). The following immunophenotype of the aforementioned cells were revealed: CD45 (+, weaker than in T cells), CD30 (+, strong cytoplasmic and membranous), CD15 (+/-, weak cytoplasmic and in Golgi system in some cells), CD20 (+, membranous, weaker than in B cells), OCT (+/-, strong nuclear on the majority of the cells), BOB1 (-/+, trace in single cells), CD10 (-), Bcl6 (-), ALK1 (-), CD3 (-), S100 (-), and CD1a (-). Prognostic markers on Hodgkin and Reed-Sternberg (HRS) cells were as follows: Bcl2 (+, cytoplasmic, weaker than T cells), Ki67 (+, strong in almost all HRS cells), and CD68 (+++) in many concomitant macrophages (category 3) (Figures 3D,E). Classical Hodgkin lymphoma (cHL) of the CNS, mixed cellularity subtype (MCcHL) was diagnosed. Correlation between the reactivation of Epstein-Barr virus (EBV) with the positive EBV/LMP1 immunostaining was emphasized (Figure 3F).