[Syncytial variant of the nodular sclerosing type of Hodgkin's disease in cervical lymph nodes with simultaneous sarcoidosis-like granulomatosis in the intrathoracic lymph nodes and liver].

A woman aged 31 years had been afflicted with mediastinal lymph node enlargement and hepatopathy for two years. Epithelioid-cell granulomatosis was diagnosed at another institute on the basis of biopsies taken from the liver and thoracic lymph nodes, resulting in the differential diagnosis of sarcoidosis or tuberculosis. Another biopsy was taken from enlarged cervical lymph nodes, after tuberculostatic therapy had remained unsuccessful and had not prevented deterioration of the patient's condition. We diagnosed from that biopsy the syncytial variant of nodular sclerosis of Hodgkin's disease. Immunohistochemically, the tumour cells exhibited positive reactions to antigens CD 15 and CD 30, whereas no evidence was provided to the presence of cytokeratins, lysozyme and S-100 protein. In grading, we associated our case with subtype 2 of nodular sclerosis and clinical stage II. Combined radiotherapy and chemotherapy resulted in complete remission of the tumour disease. Presence of granulomatosis similar to sarcoidosis was confirmed by follow-up examination of the liver and lymph node biopsies which originally had been histopathologically examined at another institute. The question is discussed whether or not this granulomatous reaction reflected an increased immunological defence reaction of the organism to Hodgkin's disease and thus offered an explanation for the unexpected favourable course of the patient's disease.