Thursday, March 29, 2007, 7:30 PM
Convention Center 5 A/B
Hodgkin Lymphoma and Its Differential Diagnosis
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MARSHA C. KINNEY
University of Texas Health Science Center
San Antonio, TX
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Submitted by: Yashoda Natkunam - Stanford University Medical Center, Stanford, CA
The patient is a 61-year old man who presents with a mesenteric mass. A 5.0 cm mesenteric lymph node was excised. Approximately thirty years previously the patient had undergone a supraclavicular lymph node biopsy and the diagnosis of nodular sclerosis classical Hodgkin lymphoma was rendered for which he received chemotherapy and radiation. The patient had undergone two subsequent lymph node biopsies at 4 and 13 years after his initial treatment. Both of these biopsies had shown reactive follicular hyperplasia with progressive transformation of germinal centers.
Case 1 - Slide 1
Submitted by: Judith Ferry - Massachusetts General Hospital, Boston, MA
The patient was a 33-year-old attorney who presented initially with mild dyspnea, possibly in association with a cold. His symptoms resolved, but a few weeks later he noted an unusual sensation, described as a tightening or tingling, in his right chest on deep inspiration. He also had low-grade fever but no weight loss or convincing night sweats. He had a history of infectious mononucleosis during high school, but his past medical history was otherwise unremarkable.
Radiographic evaluation revealed a 6 x 8 cm mediastinal mass. Biopsies of the mass were performed.
Case 2 - Slide 1
Submitted by: Stefania Pittaluga - National Cancer Institute, Washington, DC
83 year old male who presented with generalized adenopathy, night sweats, and fatigue; he was treated with hyper-CVAD and went into CR for four months. Recurrent adenopathy developed in the right neck.
Submitted biopsy: Lymph node, right inguinal (pre-treatment)
Flow cytometry: 16% aberrant T cells with down-regulation of CD3 and CD7.
Other markers: CD2 moderately positive; CD5 moderately positive, CD8 negative, CD13/33 negative, CD19 negative, CD20 negative, CD22 negative, CD23 negative, CD38 variably positive, CD56 negative, kappa negative, lambda negative.
Molecular studies were performed. Southern blot analysis using EcoRI, BamH1+HindIII, XbaI using TCRbeta (constant region and J2) showed rearranged bands in all three digestions.
TCRgamma PCR: Clonal rearrangement detected
IgH PCR: Polyclonal pattern detected.
Case 3 - Slide 1
Submitted by: Jonathan Said - UCLA Center for Health Sciences, Los Angeles, CA
The patient is a 76-year old man with a history of left supraclavicular and cervical lymphadenopathy for at least one year without splenomegaly or constitutional 'B' symptoms. On specific questioning he was found to have a history of rheumatoid arthritis, but was never on immunosuppressive medication. The lymph node biopsy was from the supraclavicular lymph node.
(I am grateful to Dr. Timothy S. Braverman at the Jewish Hospital in Cincinnati OH for permission to use this case.)
Case 4 - Slide 1
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