Retroperitoneal Hodgkin Lymphoma with Giant Renal Cyst: Case Report

Detection of Hodgkin’s lymphoma at earlier stages increases the chances of successful chemotherapy treatment. Retroperitoneal localization makes the diagnosis difficult, which can delay treatment. we report here the case of 65-year-old patient presenting right lumbar pain for 2 years, who was admitted for surgical exploration of a fluid retroperitoneal mass, after an inconclusive CT-guided biopsy and a surgical biopsy showing reactive lymph node tissue remodeled without tumor element. after operating the patient, the pre-cellar lymph node dissection concluded with classic Hodgkin lymphoma.

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Classic Hodgkin Lymphoma With Intrasinusoidal Pattern of Infiltration and Concurrent Plasma Cell Variant of Castleman Disease

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqz121.021 ◽

2019 ◽

Vol 152 (Supplement_1) ◽

pp. S113-S113

Author(s):

Sean Barrett ◽

Katsiaryna Laziuk ◽

Richard Hammer

Keyword(s):

Bone Marrow ◽

Lymph Node ◽

Hodgkin Lymphoma ◽

Plasma Cell ◽

Plasma Cells ◽

Large Cell ◽

Castleman Disease ◽

Neoplastic Cells ◽

Classic Hodgkin Lymphoma ◽

Cell Variant

Abstract The relationship between Hodgkin lymphoma and plasma cell variant of Castleman disease is uncommon but has been previously described. Most reported cases were diagnosed concurrently. However, sinusoidal involvement by Hodgkin lymphoma is very rare and morphologically can mimic anaplastic large cell lymphoma. Here we present a case of classic Hodgkin lymphoma with a sinusoidal pattern of infiltration coexisting with the plasma cell variant of Castleman disease. A 16-year-old male presented to clinic with shortness of breath and a worsening cough with yearlong duration. Medical history revealed no autoimmune disease, but there was a prolonged allergy history with chronic sinusitis. Imaging showed a right sided mediastinal mass, supraclavicular lymphadenopathy, and pleural effusion. CBC demonstrated anemia, neutrophilia, lymphopenia, and thrombocytosis. Excision of a supraclavicular lymph node revealed effaced architecture with marked plasmacytosis in the interfollicular areas and permeation of sinusoidal spaces by neoplastic cells with morphological features of classic Reed-Sternberg/Hodgkin cells; histiocytes, neutrophils, and residual follicles with regressed germinal centers were seen in the background. Immunohistochemistry revealed strong positivity for CD30 and CD15 by the neoplastic cells as well as positivity for PAX5, MUM1, and CD200 and faint membrane positivity for CD20. The neoplastic cells were negative for CD79a, CD45, EMA, ALK1, and associated T-cell markers. CD138 highlighted increased plasma cells that were negative for CD56, CD200 and polytypic for kappa and lambda. Concurrent bone marrow biopsy revealed a normocellular bone marrow with mild plasmacytosis and no evidence of involvement by lymphoma. Both lymph node and bone marrow were negative for HHV-8. Flow cytometry of the lymph node revealed no monotypic B-cell population and T cells showed predominance of CD4-positive cells with no aberrant antigen expression. The unusual morphologic pattern of classic Hodgkin lymphoma made the diagnosis challenging, and demonstration of proper immunophenotype is required for diagnosis.

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CCR4 Expression in Hodgkin Lymphoma

Blood ◽

10.1182/blood.v118.21.2626.2626 ◽

2011 ◽

Vol 118 (21) ◽

pp. 2626-2626

Author(s):

Lydia Visser ◽

Myrna van West ◽

Bea Rutgers ◽

Sibrand Poppema ◽

Anke Van Den Berg

Keyword(s):

Lymph Node ◽

T Cell ◽

Hodgkin Lymphoma ◽

Tumor Cells ◽

Conflicts Of Interest ◽

Treg Cells ◽

Cd4 T Cell ◽

Th2 Cells ◽

Follicular Hyperplasia ◽

Reactive Lymph Node

Abstract Abstract 2626 In Hodgkin lymphoma (HL) a minority (<1%) of tumor cells is found in a reactive background. The tumor cells shape their environment by the production of several chemokines and cytokines. Production of the chemokine TARC will lead to the attraction of Th2 and Treg cells specifically to involved lymph nodes. Although Treg and Th2 cells are prominent in the infiltrate the expression of its receptor CCR4 is not very high in lymphocytes surrounding the tumor cells. We hypothesized that this is due to internalization of the receptor. We analyzed in which specific compartment of lymphocytes CCR4 is expressed and if CCR4 expression can be recovered when TARC and MDC levels are low. We analyzed 11 lymph node suspensions involved with HL and 11 with follicular hyperplasia (RLN) for expression of CD4, CD26, FoxP3 and CCR4 at t=0 and t=24 hours. We tested the effect of TARC and MDC on CCR4 expression and the mechanism of internalization on normal PBMCs. At t=0 the CD4+ T cell compartment was significantly lower for CD26 in HL (49% vs 68% in RLN, p<0.01) (Table 1). In the comparison between CD26+ and CD26- cells no difference was seen in CCR4 expression in HL but in RLN CCR4 in CD26- cells was significantly lower than in CD26+ cells (p<0.01).Recovery of CCR4 (in average %) after 24 hours was significantly lower in CD26+ cells and FoxP3+ cells in RLN (p<0.01 and p<0.001). Recovery of CCR4 as factor change is significantly higher in HL than in RLN for CCR4 as well as the 3 subpopulations (Table 2). Generally, internalization of CCR4 on lymphocytes is higher with MDC (54 to 90% internalization with 10 and 500ng/ml MDC) than TARC (28 to 48% with 10 and 1000ng/ml TARC) after 2 hours. Internalization occurs through the lipid raft/caveolae dependent pathway as filipin III could inhibit internalization completely and not by clathrin-mediated endocytosis since no effect of inhibition by sucrose was seen. Recovery of CCR4 back on the membrane is fast and by exocytosis since it can be disrupted by exocytosis inhibitor Brefeldin A.Table 1:Percentages subpopulations CD4+ T cells in Hodgkin lymphoma and reactive lymph node by flowcytometry on cell suspensionsHLRLNpCD264968<0.01CCR44137nsFoxP34.41.8nsCCR4/CD26+1925nsCCR4/CD26-2212nsCCR4/FoxP3+5560nsTable 2:Factor of CCR4 recovery after 24 hours in CD4+ subpopulations in Hodgkin lymphoma and reactive lymph node cell suspensionsHLRLNpCCR41.70.9<0.05CCR4 in CD26+1.30.8<0.05CCR4 in CD26-2.91.1<0.05CCR4 in FoxP3+1.60.8<0.05 In conclusion, CD26 expression is significantly lower in HL than RLN. CCR4 expression is equally divided over CD26+ and CD26- cells in HL, but in RLN less is found in CD26-. Recovery of CCR4 expression after culture for 24 hours is lower in RLN than in HL. More CCR4 is recovered in HL especially in the CD26- CD4+ T cell population that is surrounding the tumor cells in HL. Disclosures: No relevant conflicts of interest to declare.

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Rare, post-periodontitis spondylodiscitis caused by Fusobacterium nucleatum in a patient with multiple sclerosis: challenge of diagnosis and treatment

BMJ Case Reports ◽

10.1136/bcr-2020-239664 ◽

2021 ◽

Vol 14 (3) ◽

pp. e239664

Author(s):

Dritan Pasku ◽

Siddharth Shah ◽

Ahmed Aly ◽

Nasir A Quraishi

Keyword(s):

Multiple Sclerosis ◽

Fusobacterium Nucleatum ◽

Mri Scan ◽

Surgical Biopsy ◽

Ct Guided ◽

Commensal Flora ◽

Immunsuppressive Therapy ◽

Ct Guided Biopsy ◽

History Of

Fusobacterium nucleatum is part of the commensal flora of the oral cavity, frequently associated with periodontal infections. We describe the case of a 49-year-old woman, on immunsuppressive therapy for multiple sclerosis, who presented with a 3-month history of debilitating back pain. She had a recent episode of periodontitis, and was under regular dental review. Her MRI scan demonstrated findings suggestive of L2–L3 spondylodiscitis. Her CT-guided biopsy yielded negative cultures and the patient failed two courses of empirical antibiotic treatment. With clinical and radiological disease progression, she underwent a percutaneous disc washout and biopsy, which subsequently grew F. nucleatum. Treatment with clindamycin and metronidazole was commenced orally for 6 weeks. She improved gradually, and at 1 year follow-up was asymptomatic. The diagnosis of spondylodiscitis caused by F. nucleatum is challenging. The perseverance on identification by surgical biopsy, minimally invasive washout and targeted antibiotics are the mainstay of effective treatment.

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Incidence of adnexal and lymph node metastases in endometrial stromal sarcoma

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.5589 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. 5589-5589 ◽

Cited By ~ 1

Author(s):

L. dos Santos ◽

K. Garg ◽

J. P. Diaz ◽

R. A. Soslow ◽

M. L. Hensley ◽

...

Keyword(s):

Lymph Node ◽

Statistical Tests ◽

Endometrial Stromal Sarcoma ◽

The Other ◽

Ct Guided ◽

Stromal Sarcoma ◽

Primary Surgery ◽

Adnexal Tumor ◽

Ct Guided Biopsy ◽

Node Metastases

5589 Background: To determine the incidence of adnexal and lymph node (LN) metastases in endometrial stromal sarcoma (ESS). Methods: We identified all cases evaluated at our institution with a diagnosis of ESS from January 1, 1980 to December 31, 2007. All uterine pathology was reviewed at our center. High-grade or undifferentiated tumors and ESS arising in extrauterine sites were excluded. Pertinent clinical data were abstracted from electronic medical records. Appropriate statistical tests were performed using SPSS 15.0. Results: We identified 91 cases with ESS. All except two underwent hysterectomy. Eighty-four cases (92%) underwent salpingo-oophorectomy (bilateral in 81 [96%]). Adnexal metastases were identified in 8 (9.5%) of 84 cases. All adnexal metastases were manifested by gross adnexal tumor and occurred in patients with other gross pelvic extrauterine disease. Seven of these 8 patients also had lymph-vascular space invasion (LVSI). LVSI status was not reported in the other patient. In patients with gross pelvic extrauterine disease, adnexal metastasis did not affect survival. LN metastases were identified in 8 (24%) of the 34 patients who underwent LN evaluation. Thirty-three evaluations were performed intraoperatively and one was via postoperative CT-guided biopsy of an enlarged LN. Five of the 8 cases with LN metastases had LVSI. LVSI status was not reported in the other 3 cases. Of 20 patients with disease grossly limited to the uterus and grossly normal LN, 2 (10%) had LN metastases. Both of these cases had LVSI and extensive myoinvasion approaching the serosa. Four of the remaining 6 patients with LN metastases had grossly positive LN and other gross extrauterine disease. The final 2 patients had grossly positive LN without other extrauterine disease. Conclusions: The incidence of LN metastases in ESS is most commonly associated with gross extrauterine disease, extensive myoinvasion and LVSI. However, since myoinvasion and LVSI status often are not assessable at the time of initial hysterectomy, LN dissection remains a reasonable option at primary surgery. The rate of adnexal metastasis appears to be negligible in the absence of gross adnexal and extrauterine tumor, but there may be a role for oophorectomy in the hormonal management of ESS. No significant financial relationships to disclose.

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Concomitant Classic Hodgkin Lymphoma of Lymph Node and cMYC-Positive Burkitt Leukemia/Lymphoma of the Bone Marrow Presented Concurrently at the Time of Presentation: A Rare Combination of Discordant Lymphomas

Clinical Medicine Insights Blood Disorders ◽

10.4137/cmbd.s39908 ◽

2016 ◽

Vol 9 ◽

pp. CMBD.S39908 ◽

Cited By ~ 1

Author(s):

Dina S. Soliman ◽

Shehab Fareed ◽

Einas Alkuwari ◽

Halima El-Omri ◽

Ahmad Al-Sabbagh ◽

...

Keyword(s):

Bone Marrow ◽

Lymph Node ◽

Hodgkin Lymphoma ◽

Rare Combination ◽

Classic Hodgkin Lymphoma ◽

Time Of Presentation

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Clonally-Related Composite Classic Hodgkin Lymphoma and Follicular Lymphoma

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqab191.213 ◽

2021 ◽

Vol 156 (Supplement_1) ◽

pp. S100-S101

Author(s):

D P Larson ◽

R P Ketterling ◽

R He ◽

M Shi ◽

E D McPhail ◽

...

Keyword(s):

Lymph Node ◽

Follicular Lymphoma ◽

B Cell ◽

Hodgkin Lymphoma ◽

Germinal Center ◽

B Cell Lymphoma ◽

Mediastinal Lymphadenopathy ◽

Classic Hodgkin Lymphoma ◽

History Of ◽

Igh Rearrangement

Abstract Introduction/Objective Composite classic Hodgkin lymphoma and follicular lymphoma (CHLFL), defined as CHL and FL occurring simultaneously at the same site, is rare and poorly understood. While both Hodgkin/Reed-Sternberg (HRS) cells and FL are thought to be derived from germinal center B-cells, the relationship between CHL and FL when coexistent is unclear. Here, we present two cases of CHLFL and show that the CHL and FL components have a clonal relationship by FISH. Methods/Case Report Case #1 is a 50-year-old man with abdominal and mediastinal lymphadenopathy. An excised mesenteric lymph node showed two distinct components diagnostic for FL, grade 1-2 and CHL. Case #2 is a 63-year- old woman with a history of FL with transformation to diffuse large B-cell lymphoma. Cytogenetic studies showed a complex karyotype with an add(9p), del(10q), and trisomy 16. Post-treatment imaging revealed left axillary adenopathy. An excised axillary lymph node showed CHL with peripheral areas of FL, grade 3A. Both cases had areas of typical FL with BCL2-positive phenotype and no significant CD30/CD15 expression. HRS cells were CD45/CD20-negative, expressed CD30 (strong), CD15, and PAX5, and were present in a mixed inflammatory background. No EBV RNA was present by in situ hybridization. Interestingly, HRS cells in case #1 expressed both BCL6 and BCL2. FISH was performed in both cases. Case #1 had a BCL2 rearrangement in 48% of FL nuclei and in 100% of HRS cells. In case #2, targeted probes were used based on prior cytogenetic results. Here, 47% of FL nuclei and 44% of HRS cells had a 16p duplication; additionally, 32% of HRS cells had an unbalanced IGH rearrangement with loss of the IGH variable region, suggesting possible clonal evolution. No rearrangement of BCL2 or BCL6 was present. An additional 27 CHLFL cases from the literature were reviewed. CHLFL was mostly nodal and occurred in late adulthood in patients with or without a history of FL. It presented at advanced clinical stage, with a 5-year overall survival of 22%. BCL2 expression in HRS cells was common. Bone marrow involvement was 45% (5/11) and consisted of FL exclusively. Five of six tested cases demonstrated BCL2/IGH rearrangement in both FL and HRS cells. Results (if a Case Study enter NA) NA Conclusion Composite CHL and FL are often clonally related and may share a common progenitor B-cell origin – likely a germinal center B-cell – from which additional genetic abnormalities are acquired to develop two distinct lymphomas.

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Single-cell profiling reveals the importance of CXCL13/CXCR5 axis biology in lymphocyte-rich classic Hodgkin lymphoma

Proceedings of the National Academy of Sciences ◽

10.1073/pnas.2105822118 ◽

2021 ◽

Vol 118 (41) ◽

pp. e2105822118

Author(s):

Tomohiro Aoki ◽

Lauren C. Chong ◽

Katsuyoshi Takata ◽

Katy Milne ◽

Ashley Marshall ◽

...

Keyword(s):

T Cells ◽

Single Cell ◽

Hodgkin Lymphoma ◽

Immune Cell ◽

Cell Subset ◽

Progression Free Survival ◽

Tissue Microarrays ◽

Classic Hodgkin Lymphoma ◽

Reactive Lymph Node ◽

Technical Advances

Lymphocyte-rich classic Hodgkin lymphoma (LR-CHL) is a rare subtype of Hodgkin lymphoma. Recent technical advances have allowed for the characterization of specific cross-talk mechanisms between malignant Hodgkin Reed-Sternberg (HRS) cells and different normal immune cells in the tumor microenvironment (TME) of CHL. However, the TME of LR-CHL has not yet been characterized at single-cell resolution. Here, using single-cell RNA sequencing (scRNA-seq), we examined the immune cell profile of 8 cell suspension samples of LR-CHL in comparison to 20 samples of the mixed cellularity (MC, 9 cases) and nodular sclerosis (NS, 11 cases) subtypes of CHL, as well as 5 reactive lymph node controls. We also performed multicolor immunofluorescence (MC-IF) on tissue microarrays from the same patients and an independent validation cohort of 31 pretreatment LR-CHL samples. ScRNA-seq analysis identified a unique CD4+ helper T cell subset in LR-CHL characterized by high expression of Chemokine C-X-C motif ligand 13 (CXCL13) and PD-1. PD-1+CXCL13+ T cells were significantly enriched in LR-CHL compared to other CHL subtypes, and spatial analyses revealed that in 46% of the LR-CHL cases these cells formed rosettes surrounding HRS cells. MC-IF analysis revealed CXCR5+ normal B cells in close proximity to CXCL13+ T cells at significantly higher levels in LR-CHL. Moreover, the abundance of PD-1+CXCL13+ T cells in the TME was significantly associated with shorter progression-free survival in LR-CHL (P = 0.032). Taken together, our findings strongly suggest the pathogenic importance of the CXCL13/CXCR5 axis and PD-1+CXCL13+ T cells as a treatment target in LR-CHL.

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Imaging of esophageal tuberculosis: A review of 23 cases

Acta Radiologica ◽

10.1080/j.1600-0455.2003.00069.x ◽

2003 ◽

Vol 44 (3) ◽

pp. 329-333

Author(s):

B. Nagi ◽

A. Lal ◽

R. Kochhar ◽

D. K. Bhasin ◽

M. Gulati ◽

...

Keyword(s):

Lymph Nodes ◽

Spinal Tuberculosis ◽

Mediastinal Lymphadenopathy ◽

Barium Swallow ◽

Surgical Biopsy ◽

Ct Guided ◽

Antituberculous Treatment ◽

Esophageal Tuberculosis ◽

Extrinsic Compression ◽

Ct Guided Biopsy

Purpose: To evaluate the various radiological abnormalities in patients with proven esophageal tuberculosis. Material and Methods: The case records of 23 patients with proven esophageal tuberculosis were evaluated retrospectively for various radiological abnormalities. Twenty-two patients had secondary involvement of esophagus in the form of direct extension of mediastinal and pulmonary tuberculosis or spinal tuberculosis. Only 1 patient had primary involvement of the esophagus with no evidence of disease elsewhere. The diagnosis was confirmed by endoscopic and CT-guided biopsy/aspiration cytology in 7 and 6 cases, respectively. Diagnosis was made on the basis of surgical biopsy of lymph node and autopsy in 1 patient each. In the remaining 8 patients the diagnosis was based on radiological and endoscopic findings and the response to antituberculous treatment. Results: Chest radiography (CXR) was abnormal in 65% patients. While the findings were non-conclusive for esophageal tuberculosis, characteristic lesions of tuberculosis in lungs or spine were suggestive of tuberculous etiology. In 15 patients, CT of the chest confirmed the corresponding CXR findings and also showed additional findings of mediastinal lymphadenopathy when CXR was normal. Fourteen patients showed mediastinal lymphadenopathy on CT of the chest. In all these patients, more than one group of lymph nodes was involved. The characteristic hypodense center of lymph nodes suggestive of tuberculosis was seen in 12 patients. Radiological abnormalities seen in barium swallow examination were extrinsic compression, traction diverticula, strictures, sinus/fistulous tracts, kinking and pseudotumor mass of esophagus in decreasing order of frequency. The middle third of the esophagus was found to be the most frequent site of involvement.

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