The infiltration of classical Hodgkin lymphoma cells into pleural effusion

Excerpt

A huge mediastinal mass was detected in a 64-year-old male patient who underwent a chest X-ray examination due to an uncomfortable sensation in his chest. He also had lesions in the right axillary lymph nodes and bone marrow. The immunophenotype of the tumor cells was CD45⁻/CD15⁺/CD30⁺/CD20⁻/CD79a⁻/PAX5⁻/CD3⁻/CD5⁻/CD43⁻/ALK⁻/AE1/AE3⁻/S-100⁻. Although the findings were PAX5 negative, the patient was diagnosed with lymphocyte-depleted classical Hodgkin lymphoma, clinical stage IVA (Fig. 1a, b). He received eight courses of adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD) chemotherapy followed by involved field irradiation; however, his lymphoma relapsed 4 years later with multiple liver lesions. Although he received brentuximab vedotin, his lymphoma progressed and infiltrated multiple lymph nodes, bones, and the pleura with effusion. A laboratory test of aspirated pleural effusion showed a specific gravity 1.019, TP 4.5 g/dL, Alb 2.3 g/dL, and LD 4908 U/L. The differential count of the smear preparation was as follows: neutrophils 11%, lymphocytes 9%, macrophages 18%, and abnormal cells 61%. The size of the abnormal cells was medium to large with a weakly basophilic cytoplasm. Their nuclei were irregularly shaped with large and prominent nucleoli (Fig. 1c–f). Cell block preparation also showed a large number of large tumor cells. The immunophenotype in the cell block and pleural biopsy was CD45⁺/CD15⁻/CD30⁺(partial)/CD20⁻/CD79a⁻/PAX5⁻/CD3⁻/CD43⁻/ALK⁻ (Fig. 1g, h), which was roughly consistent with the primary lesion. The chromosomal analysis of the cells from the pleural effusion revealed that they were basically tetraploid accompanied by t(3;14)(q27;q32); however, the IGH–BCL6 rearrangement was not detected by a FISH analysis.

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