We are presenting here a new case of the tumor of the enlarged right inguinal lymph node in a 18-year-old boy.  
No other signs of disease were detected on clinical examination.  
Laboratory findings unremarkable.  
Microscopically, lymph node was composed of mixed population of the cells including lymphocytes, plasma cells, eosinophils with presence of large, mono- and binuclear cells located mainly within the interfollicular areas and sinuses.  
Immunohistochemistry: Atypical cells positive for CD15, CD30, EMA while negative for ALK, CD20 and CD3.  
Clinical diagnosis: No  
Histopathological diagnosis: Hodgkin's disease or ALCL?  
Please, give your opinion!

diane.c.farhi 2007-11-07 17:40	[comment sent by email] I favor Hodgkin lymphoma. I agree that the large RS-like cells of   interest are CD3 negative. With regard to the other stains, in my   opinion CD15 positivity in seen mainly in small cells, probably   granulocytes; I don't see any RS-like cells in these photos. CD20   positivity is seen mainly in small cells, probably B cells, and in one   RS-like cell showing faint perinuclear positivity. CD30 positivity is   seen mainly in plasma cells; I don't see any RS-like cells in these   photos. EMA is positive in one large abnormal cell. Staining for CD45   might be helpful.
SergeyN 2007-11-08 10:53	Looks like Hodgkin, classical.     In any case, one would be more happy with a more objective histological verification in a 18-year boy with a single atypical localisation.     Is it possible to have an image of CD30 and CD15 of a field with several large cells? It would be preferable if there are CD30+ plasma cells and CD15+ granulocytes in the neighbouhood to exclude false-negative results.     CD45 would be nice, but we could have problems with its interpretation on images. Do you have CD79a?     Clinically: are there B-symptoms by chance?
tzankov 2007-11-08 12:21	I have little to add to the previous two remarks, Hodgkin lymphoma is the fist differential. the strong EMA expression is not very typical for classical Hodgkin lymphoma, but does not at all exclude it. please show convincing expression of CD30 and CD15 on the large cells (preferrably at 400x magnification). LMP-1 stains, as well as PAX-5, CD57 and ALK1 would be of some help.
semir 2007-11-08 16:11	Thank for you all valuable comments.   We have just added several more figures in order to clarify this case.
hurwitz 2007-11-08 20:19	For me as well this is a CHL, mixed cellularity. The recently added CD30 staining is convincing. Please excuse an oldfashioned remark: The morphology on your nice H&E stained sections is at least as convincing as IHC.
anpo 2007-11-08 23:43	I agree with Nina that in this case a diagnosis of Hodgkin lymphoma mixed cellularity could have been made on morphology alone. In the first photos stained with CD30 there is a lot of background and staining in plasma cells.
tzankov 2007-11-09 08:35	Considering the convincing CD30 figure, I fully agree with the diagnosis of classical Hodgkin lymphoma.
hurwitz 2007-11-12 22:12	Final diagnosis: Classical Hodgkin's lymphoma
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