Analysis of clinico pathological features of Hodgkin lymphoma in Pakistan

Abstract

Introduction: Hodgkin lymphoma (HL), formerly called Hodgkin's disease, arises from germinal center or postgerminal center B cells. HL has a unique cellular composition, containing a minority of neoplastic cells (Reed- Sternberg cells and their variants) in an inflammatory background. Aims and objectives: The main objective of the study is to analyze the clinico pathological features of classic and non-classic Hodgkin lymphoma in Pakistan. Material and methods: This study was conducted in Yusra General Hospital during 2018 with the permission of ethical committee of hospital. This was basically a case study which was seen in Yusra General Hospital. There was a female in her 60s who presented with cervical lymphadenopathy associated with heavy infection with Epstein-Barr virus (EBV), diagnosed as Hodgkin lymphoma, mixed cellularity. During the staging workup, the patient was discovered to have extensive bone marrow (BM) involvement by Burkitt leukemia/lymphoma (BL). A diagnosis of concomitant EBV-related discordant lymphoma (cHL and BL) in leukemic phase was made.Results: Histopathological examination of the LN revealed subtotal effacement of the nodal tissue by a diffuse proliferation of lymphoid cells intermixed with scattered histiocytes, plasma cells, and eosinophils. There were many large atypical cells consistent with Hodgkin/Reed–Sternberg cells and mummified cells seen in the reactive background. As the patient’s general condition had rapidly deteriorated and as a part of staging workup for HL, BM examination was performed. The BM aspirate smear unexpectedly showed infiltration with monotonous population of leukemic cells (~27%), medium size with regular round nuclei, dispersed nuclear chromatin, deeply basophilic cytoplasm with prominent vacuolation. Conclusion: It is concluded that correct diagnosis and appropriate treatment for composite CHL and B-NHL is highly important in patient’s ≥40 years old. CHL must continue to be recognized because the disease subsets may have variable natural histories, prognosis, and different treatment modalities.