PMC5818959_01
Haemotoxylin and eosin (H&E) stain (a) at 400x magnification showing a diffuse appearing infiltrate composed of scattered large atypical cells in a background of smaller lymphocytes and histiocytes and (b) at 600x magnification showing lymphocyte predominant cells. (c) CD3 stain highlights abundant background T cells and shows a hint of nodularity (center) shown at 100x magnification. (d) Large tumor cells are strongly positive for PAX5. Note the presence of the nodule of tumor cells in the center.
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fig1
CD3- and CD163-positive stains highlighted an abundant background of T cells and histiocytes, respectively (see Figures 1 and 2 for pathology slides). Given the focal nodularity and the patient's prior history of NLPHL, diagnosis was best classified as NLPHL-THRLBCL-like (old terminology) now updated in the new 2016 WHO classification as "THRLBCL-like transformation of NLPHL" (see Figures 1 and 2 for pathology description).
(a) CD21 stain highlights rare dendritic meshworks shown at 200x magnification. (b) The large tumor cells are strongly positive for CD45 (this is essential in excluding classical Hodgkin lymphoma from the differential diagnosis; both NLPHL and THRLBCL will be CD45+) shown at 400x magnification. (c) CD163 stain highlights abundant background histiocytes shown at 40x magnification. (d) Large tumor cell nuclei are strongly OCT2 positive. Note the presence of tumor cells in the center shown at 100x magnification.
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fig2
CD3- and CD163-positive stains highlighted an abundant background of T cells and histiocytes, respectively (see Figures 1 and 2 for pathology slides). Given the focal nodularity and the patient's prior history of NLPHL, diagnosis was best classified as NLPHL-THRLBCL-like (old terminology) now updated in the new 2016 WHO classification as "THRLBCL-like transformation of NLPHL" (see Figures 1 and 2 for pathology description).
Treatment schema.
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fig3
The Deauville score was five (see Figure 3 outlining his treatment schema).
PET-CT images: 3-dimensional MIP images.
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fig4
PET-CT scan performed five months after lenalidomide initiation showed resolution of the previously noted lesions in the bones, lymph nodes, and liver (see Figures 4-6 for PET-CT image comparison showing resolution of the disease).
Fused PET-CT images: abdominal window showing resolution of liver and spleen lesions (a) prior to lenalidomide use and (b) after lenalidomide use.
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fig5
PET-CT scan performed five months after lenalidomide initiation showed resolution of the previously noted lesions in the bones, lymph nodes, and liver (see Figures 4-6 for PET-CT image comparison showing resolution of the disease).
Fused PET-CT images: bone window showing resolution of bone lesions (a) prior to lenalidomide use and (b) after lenalidomide use.
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fig6
PET-CT scan performed five months after lenalidomide initiation showed resolution of the previously noted lesions in the bones, lymph nodes, and liver (see Figures 4-6 for PET-CT image comparison showing resolution of the disease).