PMC3898043_01
Initial radiologic staging confirming lymphoma Ann Arbor stage IV. (A) T1 weighted images after i.v. contrast administration demonstrate left cervical lymphadenopathy (arrows). (B) Pathological enlargement and contrast uptake is also noted in left supraclavicular (arrows) and right paratracheal (dotted arrow) lymph nodes. Delayed phase VIBE sequence demonstrates a lung nodule (C) and left paraaortic lymphadenopathy (D). Multiple hypointense liver lesions are noted in the VIBE sequence acquired in portal venous phase (E + F). These findings are consistent with HL with nodal, hepatic and pulmonary involvement.
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F1
MRI scan (Figure 1) and revealed a large cervical lymph node bulk (8 x 3.3 cm) on the left side and slightly enlarged cervical, paratracheal and paraaortal lymph nodes on the right side. Moreover, there were two small masses in the left lung (13 mm and 7 mm in diameter, respectively) as well as multiple hepatic nodules.
Liver Biopsy documenting hepatic involvement of Hodgkin's lymphoma. (A) Histology of classical HL with lacunar cells and mixed inflammatory background. Hodgkin cells express a characteristic immunophenotype with strong positivity for CD30 (B) and weak expression of CD20 (C). CD15 staining (A) highlights few histocytes. (D) Histology of classical HL with lacunar cells and mixed inflammatory background.
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F2
Ultrasound-guided biopsy of liver nodules was performed immediately and showed multiple small nodular infiltrates of classical Hodgkins lymphoma (Figure 2).