Classical Hodgkin lymphoma (cHL) and non-Hodgkin lymphoma rarely develop in the same patient synchronously or metachronously. Through a series of biopsies, we report a unique case of diffuse large B-cell lymphoma (DLBCL) with stepwise development of classical Hodgkin lymphoma. An intermediate stage of transformation was identified with scattered Reed-Sternberg/Hodgkin cells present in a background of the DLBCL cells. These Reed- Sternberg/Hodgkin cells showed typical immunophenotype of cHL cells and were associated with limited inflammatory cells. While Reed-Sternberg/Hodgkin-like cells are not uncommonly seen in a variety of non-Hodgkin lymphomas, the subsequent development of cHL in this patient indicated that the scattered Reed-Sternberg/Hodgkin cells among DLBCL cells truly represented a precursor of cHL. This would be extremely challenging, if not impossible, for pathologists to diagnose. We also highlight the importance of clinicopathological correlation and the crucial role of additional biopsies.
Diffuse Large B Cell Lymphoma Relapsing as Classical Hodgkin Lymphoma: Report of Two Cases and Review of Literature
