Mycosis Fungoides in Transformation with CD30-Positive Hodgkin-Like cells Mimicking Classic Hodgkin Lymphoma

Lessons From the Friday Unknowns

The patient has a history of mycosis fungoides. She presented with enlarged pelvic lymph nodes and a left iliopsoas lesion and needle biopsy was performed.

Histologic sections show needle-shaped fragments of lymph node tissue replaced by lymphoma.

The neoplasm is composed of numerous large atypical and anaplastic cells in a background of small lymphocytes, histiocytes, scattered eosinophils, and plasma cells. Areas of reactive fibrosis with plamacytosis are also detected.

The large anaplastic cells are positive for CD30 (strong), MUM1 (subset), EMA (weak), and CD43 (subset), and are negative for CD1a, CD3, CD4, CD5, CD7, CD8, CD10, CD15, CD20, CD45, CD56, TIA–1, p63, keratin (AE1/AE3), ALK–1 and BCL-6. A subset of atypical cells may be positive for CD2. Many reactive CD1a-positive cells are intermixed with the neoplastic cells. The antibody specific for Ki-67 shows an overall proliferation rate of 30–40%.

CD30 stain

Flow cytometry immunophenotypic analysis was performed on a cell suspension of this specimen. The study showed no support for a lymphoproliferative disorder, with only 0.4% large T cells that expressed CD4, and no evidence of aberrant antigen expression.

Although negativity for T-cell markers and CD45, and strong positivity for CD30 are suggestive of Classic Hodgkin lymphoma, with the history of mycosis fungoides, the findings are consistent with CD30+ large cell transformation of mycosis fungoides mimicking Classic Hodgkin lymphoma.

Link to digital slides:| Slides labeled case 2

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