Lymphocyte-depleted classic Hodgkin lymphoma with primary extranodal disease: Two cases that highlight the combination of immunodeficiency and immune escape in the pathogenesis

Abstract

The lymphoma classification is evolving with the continuously deepening understanding of the biology of programmed death ligand 1 (PD-L1). This understanding is exemplified by the great success of immunotherapies that block PD-L1 in classic Hodgkin lymphoma (CHL). [1][2][3] Alterations in the PD-L1 gene and protein expression are now regarded as a defining feature of CHL. This feature led to a diagnostic consensus that also includes lymphocytedepleted CHL (LD-CHL). LD-CHL is an enigmatic disease with a highly variable histopathological appearance and widespread involvement. 2,4 We describe two patients with LD-CHL and primary extranodal disease that involved, in one case, the uterus, and in the second case, the bone marrow. The description of this abnormal disease pattern can shed light on the unique biological behavior of this immunee s c a p e -r e l a t e d l y m p h o i d n e o p l a s m i n h o s t s w i t h immunodeficiencies.