Sakai Jun, Tanae Ken, Takahashi Naoki, Nagata Koji, Yoshino Tadashi, Tamaru Jun-Ichi, Niitsu Nozomi
Department of Hematology, International Medical Center, Saitama Medical University.
J Clin Exp Hematop. 2015;55(1):23-8. doi: 10.3960/jslrt.55.23.
A 35-year-old man was referred to our hospital because of left supraclavicular and cervical lymphadenopathies. Histopathological examination of the lymph nodes revealed reactive lymphadenopathy. He visited our hospital three years after the initial diagnosis because of enlarged left cervical lymph nodes. Histopathologically, both Hodgkin/Reed-Sternberg (H/RS) and lymphocyte-predominant (LP) cells were found in the lymph node. We first suspected nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL), because these cells were CD15(-) and CD30(-). However, the diagnosis of lymphocyte-rich classical Hodgkin lymphoma (LRCHL) was finally confirmed, because these cells were found to be CD20(-), Bob.1(+), Oct.2(-), and BCL6(-) by additional immunostaining. The patient was treated with six cycles of ABVD chemotherapy, and a complete response was achieved. However, he underwent autologous stem-cell transplantation after high-dose chemotherapy owing to a relapse 10 months after primary treatment. Distingushing LRCHL from NLPHL was difficult in this patient, because histopathological examination showed both H/RS and LP cells, and immunostaining revealed these cells to be triple negative (CD15(-), CD30(-) and CD20(-)). Accumulation of such cases are necessary to establish better criteria for the differential diagnosis and assessment of clinical behavior.
一名35岁男性因左锁骨上和颈部淋巴结肿大被转诊至我院。淋巴结组织病理学检查显示为反应性淋巴结病。初次诊断三年后，他因左颈部淋巴结肿大再次来我院就诊。组织病理学检查发现淋巴结中既有霍奇金/里德-斯腾伯格（H/RS）细胞，也有淋巴细胞为主型（LP）细胞。我们最初怀疑是结节性淋巴细胞为主型霍奇金淋巴瘤（NLPHL），因为这些细胞CD15（-）和CD30（-）。然而，最终确诊为富于淋巴细胞的经典型霍奇金淋巴瘤（LRCHL），因为进一步免疫组化检查发现这些细胞CD20（-）、Bob.1（+）、Oct.2（-）和BCL6（-）。该患者接受了6个周期的ABVD化疗，取得了完全缓解。然而，由于初次治疗10个月后复发，他在大剂量化疗后接受了自体干细胞移植。在该患者中，区分LRCHL和NLPHL很困难，因为组织病理学检查显示既有H/RS细胞，也有LP细胞，免疫组化显示这些细胞为三阴性（CD15（-）、CD30（-）和CD20（-））。积累更多此类病例对于建立更好的鉴别诊断标准和评估临床行为是必要的。
