A case of Stage IA classical Hodgkin lymphoma with FDG‐avid tonsils

Abstract

A 39-year-old man presented to a neck lump clinic with a twomonth history of a lump on the right side of his neck. Following fine needle aspiration, excision biopsy was performed and revealed partial effacement of the architecture with some remaining reactive follicles. There was focal proliferation of plasmacytoid dendritic cells and there were scattered atypical mononuclear and multinucleate Hodgkin-like cells in the interfollicular areas (top left). Immunohistochemistry showed that these cells were CD20, CD30 and MUM1 positive, whereas CD3 showed large numbers of reactive T cells. The plasmacytoid dendritic cells were negative for CD20 and BCL2. Immunohistochemistry for the Epstein-Barr virus was negative. Although the immunophenotype was not entirely typical, the diagnosis was that of classical Hodgkin lymphoma with an interfollicular pattern. His staging positron emission tomography-computed tomography (PET-CT) scan showed glucose-avid lymphadenopathy in the right neck and in the palatine tonsils bilaterally, as well as in the lingual tonsil, more prominent on the right (bottom). The patient underwent bilateral tonsillectomy. Histology showed reactive lymphoid tissue with follicular hyperplasia without evidence of infiltration by lymphoma (top right). The patient was considered to have favourable stage 1 disease and treated with two cycles of doxorubicin, bleomycin, vinblastine and dacarbazine (ABVD) and 20 Gy involved field radiotherapy. Knowledge of the tonsillar histology enabled considerable reduction of the radiation field. An end-of-therapy PET-CT showed complete metabolic remission.