NODULAR SCLEROSIS HOGDKINS LYMPHOMA GRADE 2 MIMICKING ANAPLASTIC LARGE CELL LYMPHOMA - A CASE REPORT

INTRODUCTION: Hodgkin's lymphoma (HL) is a lymphoproliferative neoplasm constituting less than 1% of all neoplasms. It has been categorized into- nodular lymphocyte predominant HL and classical type with subtypeslymphocyte rich, lymphocyte depleted, nodular sclerosis and mixed cellularity. Nodular sclerosis Hodgkin's lymphoma (NSHL) is difcult to diagnose on FNA because of the lack of Reed Sternberg (RS) cells, low cellularity and difculty in identifying the counterpart of lacunar cells. CASE A 16-year-old female presented with anterior chest wall swelling si REPORT: nce 6 months measuring 5x4cm along with incidentally noted cervical lymph nodes measuring 2x2cm and 1x1cm. On examination, multiple papular skin lesions were observed. FNAC smears from cervical lymph node showed high cellularity, with sheets of binucleated and multinucleated cells having multiple nucleoli, some showing pale bluish abundant cytoplasm whereas others showing dense cytoplasm; in a background of reactive lymphoid population with few neutrophils. Few giant cells showed hyperchromatic nuclei. Abnormal mitosis seen. No typical RS cell was seen. Peripheral blood smear showed neutrophilic leukocytosis with no atypical cell. Possibility of NSHL was considered and biopsy advised to rule out ALCL. Histological sections showed near total effacement of lymph node architecture by nodules separated by broad brotic bands. These nodules exhibit proliferating lymphocytes with clustered lacunar cells along with some mononucleate, binucleate and multinucleated cells. Prominent mitotic activity, angiogenesis, focal micro abscesses were noted. Immunohistochemistry showed CD 15+ and CD 30+ expression in the giant cells, conrming diagnosis of NSHL grade 2. NSHL poses a cytological diagnostic dilemma specially in abse CONCLUSION: nce of sclerosis on FNA, making histological examination and IHC mandatory

Prospects for predicting the course of nodular sclerosis Hodgkin lymphoma by morphometric analysis of CD163-positive macrophages

Background. In present days, much attention is paid to the study of the interrelation between the macrophage/hystiocytic microenvironment and the tumor substrate in lymphoproliferative disorders.Objective. The article is devoted to the morphometric and morphological assessment of CD163-positive macrophages in nodular sclerosis Hodgkin lymphoma.Materials and methods. Formalin fixed, paraffin-embedded (FFPE) lymph node samples of 45 patients were used for the study. To identify and visualize CD163-positive cells in the test material, an immunohistochemical staining method was used.Results. The study shows that the morphometric and morphological analysis of CD163-positive cells can be an effective and promising criterion for representing them as potential predictors of the disease course. Immunohistochemical study of 45 cases using the CD163 marker revealed a difference in the nature of macrophages localization in the lymph nodes nodules. The dependence of CD163-expressing cells number on the disease course was determined.Conclusion. The data obtained can be used to stratify patients with nodular sclerosis of classical Hodgkin lymphoma into risk groups and to determine personalized approaches to treatment. Immunohistochemical determination of the CD163 marker can be used in the complex diagnosis of the causes of refractoriness to the first and subsequent lines of therapy.

Autoimmune Hemolytic Anemia as Presenting Symptom of Hodgkin Lymphoma

Autoimmune hemolytic anemia (AIHA) is related to an underlying condition in an estimated 50 to 60%, while the remaining is idiopathic, as a result of a combination of immune activation, deficiency, or dysregulation. AIHA is associated with viral infections, autoimmune disorders, immunodeficiencies, lymphoproliferative disorders, and pregnancy. AIHA has predictive properties and may be a harbinger of future lymphoproliferative disorders in up to 20% of AIHA cases. Autoimmune hemolytic anemia (AIHA) has been associated with lymphoproliferative disorders particularly chronic lymphocytic leukemia and non-Hodgkin lymphoma. Rarely is it seen in Hodgkin disease. In the following report, we describe the presentation of AIHA, ultimately resulting in the diagnosis of nodular sclerosis Hodgkin lymphoma (stage III). From the limited reports and reviews available, it is understood that advanced Hodgkin (stage III or IV) of nodular sclerosis (NS) or mixed cellularity (MC) types portend a stronger affiliation to AIHA. The majority of AIHA-associated Hodgkin lymphoma presents as stage III or IV disease with the hemolysis being the presenting symptom, as in this case. The mainstay of AIHA therapy has been corticosteroids; however, this first-line regimen appears to be less effective when treating AIHA in the setting of HL. The exact mechanism of AIHA related to HL is unclear, and it may be thought to be that tumor cell produced autoantibodies. Other hypotheses include paraneoplastic phenomena or more, perhaps immunity to tumor cells may cross-react with antigens on the red cells. Although these mechanisms require further investigation, the relationship of the AIHA and HL represents a piece to a larger puzzle between autoimmune disorders and lymphoproliferative conditions.

Hodgkin's Lymphoma: Epidemiological Clinical Characteristics in a Reference Hospital in Oncology in the Eastern Amazon.

Background: Lymphomas are a type of cancer that starts in the lymphatic system. This system is made up of organs, tissues and vessels responsible for immune function. Hodgkin's lymphoma is characterized by giant cells, well differentiated and binucleated. It is divided into two groups: classical hodgkin's lymphoma and hodgkin's lymphoma predominant in nodular lymphocytes. The classic in turn is subdivided into four more histological subtypes: nodular sclerosis, rich in lymphocytes, depleted in lymphocytes and mixed cellularity. This study analyzed the spatial distribution and clinical-epidemiological and Hodgkin's lymphoma characteristics and their histological types in patients diagnosed with the disease at a Reference Hospital in Oncology in the Eastern Amazon between the years 2006 to 2015.Methods: A study was carried out cross-sectional, retrospective, analytical and descriptive study through the analysis of the medical records of 336 patients diagnosed with the disease in that given period and location, the G test was performed to demonstrate the association between the variables. Results: The cases of Hodgkin's Lymphoma came from the following Brazilian states: Pará (318 cases), Amapá (15 cases), Maranhão (2 cases), Piauí (1 case). It affected more men (62%) and young adults (mean age 26 years). The most frequent histological type was nodular sclerosis (65%). The primary location of the tumor was predominant in the cervical lymph nodes (65%). Mostly, patients with no metastases (98%), but the presence of metastases was more frequent in Hodgkin's lymphoma, Nodular Lymphocytic Predominance (18%). Conclusion: The data obtained in this study allow to know some regional peculiarities about Hodgkin's Lymphoma, which can contribute to regional preventive policies, as well as can support comparisons about the disease in other regions, contributing to better understand the heterogeneity of LH.