37 yrs male.  
HISTORY: 2007 CHL diagnosed outside (NOT INCLUDED GRAPHICS THERE). Chemo-radio therapy was applied (no details known).  
RELAPSE 2011 (1)(NOT INCLUDED GRAPHICS THERE): cHL NS 1 with IH: CD15/CD30+; CD20/CD79a/CD3(-). BM biopsy: negative. 2012 pulmonary (postterapy) resectiom: BOOP only.  
RELAPSE 2014 (2)(neck LN): the same cHL NS 2 picture with IH: CD30+ > CD15+; CD20/CD3/CD2/LCA+ (aberant); Oct2/BOB1(-); Pax5+/-(weak); ALK1/CD79a(-).  
TREATMENT: 1. BEACOPP chemo+ radio. 2. ICE chemo+ 2/double autologous Tx (2011 09 15 and 2012 01 12). 3. Radiotherapy of involved fields (PET guiding).  
 
SPECIAL POINT OF INTEREST:  
a) Genesis of "globular: and abberant expression of T Ags and Igs K >> L.  
b) CD20 and LCA aquisition (another clone? oth.?) in line with progression/large cell enumeration/NS2?.  
c) Eosinophilic RCC like cytoplasmic inclussions (maybe accumulation of proteins/fillaments with abberant IH?).  
d) Association with unfavourable course?  
 
Paraphrases (previous nodular DLBCL and DLBCL/CHL like CD30+ cases):  
https://www.ipath-network.com/inctr/object/view/577077  
https://www.ipath-network.com/inctr/object/view/578874  
 
Literature mainstay:  
1. Venkataraman G, Song JY, Tzankov A et al. Aberrant T-cell antigen expression in classical Hodgkin lymphoma is associated with decreased event-free survival and overall survival: http://www.ncbi.nlm.nih.gov/pubmed/23305738 {PMID: 23305738}  
2. Tzankov A, Bourgau C, Kaiser A et al. Rare expression of T-cell markers in classical Hodgkin's lymphoma: http://www.ncbi.nlm.nih.gov/pubmed/16056244 {PMID: 16056244}  
 
 
Thanx for continous support.

tzankov 2014-07-14 08:03

I agree with your interpretation. I would not consider the Kappa and Lambda stainings specific, since they only stain memebranes and not the cytoplasms up to the nucleus. LCA is more tricky and I think that at least one large cell is positive inside the cellular membrane, which is rather untyical for cHL, but especially if the diagnoses from 2007 and 2011 are unequivocal, the case rather runs the typical course of relapsing cHL and probably aquired some T-cell markers and CD20. I think that those "multiple" phenotypic clones reflect the dendroid tumor progession/evolution with multiple related but progressive sub-clones. What now? Allogeneous SCTx?

ugnius 2014-07-14 10:19

Thanx. Further radiotherapy (local reccurence only).