Hodgkin Lymphoma

Case contributed by Pranav Sharma


Incidental finding of lymphadenopathy

Patient Data

Age: 80 year-old
Gender: Male
Nuclear medicine

There is intense FDG activity associated supra and
infradiaphragmatic lymphadenopathy, mildly intense activity associated with
multiple hypodense lesions in the liver and spleen, and multiple intensely avid
lytic lesions scattered throughout the axial and appendicular skeleton. 
There is a small focus of intense activity in the distal sigmoid colon, which
could reflect an underlying colonic neoplasm or a lymphoma deposit, it would
appear however to be too small to be the culprit primary lesion, although this
is not excluded. A right middle lobe nodule is non avid ?malignant
lesion or granuloma. There is also right hemithorax pleural disease, however no
pleural effusion. Axillary nodes would be the most easily targeted for
histological pathological correlation.

A left adrenal gland 12mm nodule is non avid in keeping with adenoma. There is
a large left inferior calyx calcified calculus and a 8mm calcified calculus
proximally in the left ureter within the renal pelvis. Uncomplicated
cholelithiasis. Non avid prostatomegaly.

There is a large intensely avid left thyroid lobe nodule, which may reflect a
hyperfunctioning nodule, primary thyroid malignancy or possibly metastatic in

Case Discussion

This patient initially presented to our Urology Stone Clinic with left sided renal colic. He had a CT KUB done which showed a 8mm proximal left ureteric calculus with incidental finding of widespread intra-abdominal lymphadenopathy. 

He went on to have a FDG-PET scan which confirmed multiple intense FDG avid lymph nodes both supra and infra-diaphragmatically. 

He proceeded to have a US guided biopsy of left axillary lymph node which confirmed Hodgkin lymphoma. 

Histopathology findings: 

  • MACROSCOPIC: Axillary node right, three cores ranging in size from 7 mm up to 17 mm. 
  • MICROSCOPIC: Sections show cores of lymph node with effaced nodal architecture. There is fibrosis and a mixed lymphoid infiltrate including eosinophils, small lymphocytes and histiocytes. Within the mixed lymphoid infiltrate there are singly disbursed large atypical cells with morphology consistent with HRS cells. 
  • IMMUNOHISTOCHEMISRTY: Immunohistochemistry shows the large atypical cells to be CD30 +, CD20 -, PAX5 -, OCT2 and BOB1 scattered weak + cells, CD3 -, CD5 -, CD2 -, CD7 -. There are scant remnants of FDC meshwork seen on CD21. EBER-ISH -, ALK1 -.  
  • SUMMARY: Consistent with classic Hodgkin lymphoma. 

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