title: A case of composite classical and nodular lymphocyte predominant Hodgkin lymphoma with progression to diffuse large B-cell non-Hodgkin lymphoma: Diagnostic difficulty in fine-needle aspiration cytology.
abstract: A small percentage of nodular lymphocytic predominant Hodgkin lymphoma (NLPHL) progresses to diffuse large B-cell lymphoma (DLBCL). There have also been rare reports of gray zone lymphoma with features intermediate between classical Hodgkin lymphoma (CHL) and DLBCL. We report a very rare case of composite lymphoma (CHL and NLPHL) progressing to DLBCL, and highlight the diagnostic difficulty faced during its fine-needle aspiration (FNA) cytology diagnosis. A 65-year-old woman presented with a right axillary swelling which was subjected to FNA cytology. The routine FNA cytology diagnosis was anaplastic large cell lymphoma (ALCL) but immunocytochemistry did not support this diagnosis completely. The histopathological diagnosis of the excised lymph node was NLPHL with progression to DLBCL in our hospital but in a hospital abroad where the patient was treated, the reviewed diagnosis was CHL. The patient had a rapid downhill course with development of terminal pleural effusion and died approximately one year from initial diagnosis.The review of the cyto-histologic material along with additional immunocyto/histochemical studies and the clinical course of the disease support the diagnosis of a composite lymphoma (CHL and NLPHL) with progression to DLBCL. It is suggested that all the three lesions were clonally related. Diagn. Cytopathol. 2017;45:262-266. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Department of Pathology Faculty of Medicine, Kuwait University, Kuwait.|Cytology Unit, Mubarak Al-Kabeer Hospital, Kuwait.
authors.forename: Dilip K
authors.initials: DK
authors.lastname: Das
authors.affiliation: Cytology Unit, Mubarak Al-Kabeer Hospital, Kuwait.
authors.forename: Zafar A
authors.initials: ZA
authors.lastname: Sheikh
authors.affiliation: Cytology Unit, Mubarak Al-Kabeer Hospital, Kuwait.
authors.forename: Mariam H
authors.initials: MH
authors.lastname: Al-Shama'a
authors.affiliation: Department of Pathology Faculty of Medicine, Kuwait University, Kuwait.
authors.forename: Bency
authors.initials: B
authors.lastname: John
authors.affiliation: Histopathology Unit, Mubarak Al-Kabeer Hospital, Kuwait.
authors.forename: Abdulla M S
authors.initials: AM
authors.lastname: Alawi
authors.affiliation: Department of Pathology Faculty of Medicine, Kuwait University, Kuwait.|Histopathology Unit, Mubarak Al-Kabeer Hospital, Kuwait.
authors.forename: Thamradeen A
authors.initials: TA
authors.lastname: Junaid
mesh_terms: D000368:Aged; D001365:Axilla; D044963:Biopsy, Fine-Needle; D018450:Disease Progression; D005260:Female; D006689:Hodgkin Disease / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D016403:Lymphoma, Large B-Cell, Diffuse / Q000175:diagnosis*
keywords: anaplastic large cell lymphoma; classical Hodgkin lymphoma; diffuse large B-cell lymphoma; fine-needle aspiration cytology; nodular lymphocytic predominant Hodgkin lymphoma