Hodgkin Variant of Richter’s Transformation in Chronic Lymphocytic leukemia (CLL): An Illustrative Case Report and Literature Review
Hodgkin lymphoma variant of Richter’s transformation (HL-RT) is a rare event, occurring in < 1% chronic lymphocytic leukemia (CLL) cases, of which, in < 10% cases, HL is the first finding leading to a diagnosis of CLL that co-exists simultaneously. Here we report a 60 years old male patient wh...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Tehran University of Medical Sciences
2021-10-01
|
| Series: | International Journal of Hematology-Oncology and Stem Cell Research |
| Subjects: | |
| Online Access: | https://ijhoscr.tums.ac.ir/index.php/ijhoscr/article/view/1339 |
| _version_ | 1797709973708341248 |
|---|---|
| author | Nishit Gupta Aditi Mittal Rajan Duggal Tina Dadu Amit Agarwal Anil Handoo |
| author_facet | Nishit Gupta Aditi Mittal Rajan Duggal Tina Dadu Amit Agarwal Anil Handoo |
| author_sort | Nishit Gupta |
| collection | DOAJ |
| description | Hodgkin lymphoma variant of Richter’s transformation (HL-RT) is a rare event, occurring in < 1% chronic lymphocytic leukemia (CLL) cases, of which, in < 10% cases, HL is the first finding leading to a diagnosis of CLL that co-exists simultaneously. Here we report a 60 years old male patient who presented with an outside diagnosis of lymphocyte-rich classical HL. On evaluation, he had only B-symptoms in the form of low-grade fever and weight loss. Peripheral smear revealed mild leukocytosis with an absolute lymphocytosis and a few smudge cells. Bone marrow (BM) aspirate and biopsy exhibited diffuse infiltration by a small cell, low grade, Non-Hodgkin’s lymphoma with no immunohistochemical evidence of HL. Flow cytometry performed on BM was consistent with classical immunoprofile of CLL. Meanwhile the lymph node received for review revealed diffuse effacement of nodal architecture by small mature lymphocytes with immunoprofile of CLL expressing CD20, CD5, and CD23. Interspersed between these cells, were a few eosinophils along with classical Reed Sternberg cells, expressing CD30, MUM-1, CD15, and dim PAX-5, with a surrounding rosette of T-Cells highlighted by CD3 and PD-1 and negative for CD45, CD20, and EBV immunohistochemistry. Fluorodeoxyglucose positron emission tomography (FDG-PET) scan revealed hepatosplenomegaly with multiple supra/infra diaphragmatic lymph nodes. So, a final diagnosis of HL-RT in CLL was considered. The patient is currently doing well after the first cycle of ABVD chemotherapy.
HL-RT occurring in CLL is a rare event with heterogeneous clinical presentation, morphology, clonal origin, disease course, prognostic features, and survival. |
| first_indexed | 2024-03-12T06:45:31Z |
| format | Article |
| id | doaj.art-b99fa7cc6ce348949f0f0b350c342368 |
| institution | Directory Open Access Journal |
| issn | 2008-2207 |
| language | English |
| last_indexed | 2024-03-12T06:45:31Z |
| publishDate | 2021-10-01 |
| publisher | Tehran University of Medical Sciences |
| record_format | Article |
| series | International Journal of Hematology-Oncology and Stem Cell Research |
| spelling | doaj.art-b99fa7cc6ce348949f0f0b350c3423682023-09-03T00:39:03ZengTehran University of Medical SciencesInternational Journal of Hematology-Oncology and Stem Cell Research2008-22072021-10-0115410.18502/ijhoscr.v15i4.7480Hodgkin Variant of Richter’s Transformation in Chronic Lymphocytic leukemia (CLL): An Illustrative Case Report and Literature ReviewNishit Gupta0Aditi Mittal1Rajan Duggal2Tina Dadu3Amit Agarwal4Anil Handoo5Department of Haematology, BLK Superspeciality Hospital, Delhi, India, 110005Department of Haematology, BLK Superspeciality Hospital, Delhi, India, 110005Department of Histopathology, BLK Superspeciality Hospital, Delhi, India, 110005Department of Haematology, BLK Superspeciality Hospital, Delhi, India, 110005Department of Medical Oncology, BLK Superspeciality Hospital, Delhi, India, 110005Department of Haematology, BLK Superspeciality Hospital, Delhi, India, 110005Hodgkin lymphoma variant of Richter’s transformation (HL-RT) is a rare event, occurring in < 1% chronic lymphocytic leukemia (CLL) cases, of which, in < 10% cases, HL is the first finding leading to a diagnosis of CLL that co-exists simultaneously. Here we report a 60 years old male patient who presented with an outside diagnosis of lymphocyte-rich classical HL. On evaluation, he had only B-symptoms in the form of low-grade fever and weight loss. Peripheral smear revealed mild leukocytosis with an absolute lymphocytosis and a few smudge cells. Bone marrow (BM) aspirate and biopsy exhibited diffuse infiltration by a small cell, low grade, Non-Hodgkin’s lymphoma with no immunohistochemical evidence of HL. Flow cytometry performed on BM was consistent with classical immunoprofile of CLL. Meanwhile the lymph node received for review revealed diffuse effacement of nodal architecture by small mature lymphocytes with immunoprofile of CLL expressing CD20, CD5, and CD23. Interspersed between these cells, were a few eosinophils along with classical Reed Sternberg cells, expressing CD30, MUM-1, CD15, and dim PAX-5, with a surrounding rosette of T-Cells highlighted by CD3 and PD-1 and negative for CD45, CD20, and EBV immunohistochemistry. Fluorodeoxyglucose positron emission tomography (FDG-PET) scan revealed hepatosplenomegaly with multiple supra/infra diaphragmatic lymph nodes. So, a final diagnosis of HL-RT in CLL was considered. The patient is currently doing well after the first cycle of ABVD chemotherapy. HL-RT occurring in CLL is a rare event with heterogeneous clinical presentation, morphology, clonal origin, disease course, prognostic features, and survival.https://ijhoscr.tums.ac.ir/index.php/ijhoscr/article/view/1339Hodgkin’s Lymphoma; Richter’s transformation; Chronic lymphocytic leukemia (CLL); Epstein-Barr virus (EBV); Fluorodeoxyglucose positron emission tomography (FDG-PET) scan; Adriamycin, Bleomycin, Vinblastine, Dacarbazine (ABVD) chemotherapy |
| spellingShingle | Nishit Gupta Aditi Mittal Rajan Duggal Tina Dadu Amit Agarwal Anil Handoo Hodgkin Variant of Richter’s Transformation in Chronic Lymphocytic leukemia (CLL): An Illustrative Case Report and Literature Review International Journal of Hematology-Oncology and Stem Cell Research Hodgkin’s Lymphoma; Richter’s transformation; Chronic lymphocytic leukemia (CLL); Epstein-Barr virus (EBV); Fluorodeoxyglucose positron emission tomography (FDG-PET) scan; Adriamycin, Bleomycin, Vinblastine, Dacarbazine (ABVD) chemotherapy |
| title | Hodgkin Variant of Richter’s Transformation in Chronic Lymphocytic leukemia (CLL): An Illustrative Case Report and Literature Review |
| title_full | Hodgkin Variant of Richter’s Transformation in Chronic Lymphocytic leukemia (CLL): An Illustrative Case Report and Literature Review |
| title_fullStr | Hodgkin Variant of Richter’s Transformation in Chronic Lymphocytic leukemia (CLL): An Illustrative Case Report and Literature Review |
| title_full_unstemmed | Hodgkin Variant of Richter’s Transformation in Chronic Lymphocytic leukemia (CLL): An Illustrative Case Report and Literature Review |
| title_short | Hodgkin Variant of Richter’s Transformation in Chronic Lymphocytic leukemia (CLL): An Illustrative Case Report and Literature Review |
| title_sort | hodgkin variant of richter s transformation in chronic lymphocytic leukemia cll an illustrative case report and literature review |
| topic | Hodgkin’s Lymphoma; Richter’s transformation; Chronic lymphocytic leukemia (CLL); Epstein-Barr virus (EBV); Fluorodeoxyglucose positron emission tomography (FDG-PET) scan; Adriamycin, Bleomycin, Vinblastine, Dacarbazine (ABVD) chemotherapy |
| url | https://ijhoscr.tums.ac.ir/index.php/ijhoscr/article/view/1339 |
| work_keys_str_mv | AT nishitgupta hodgkinvariantofrichterstransformationinchroniclymphocyticleukemiacllanillustrativecasereportandliteraturereview AT aditimittal hodgkinvariantofrichterstransformationinchroniclymphocyticleukemiacllanillustrativecasereportandliteraturereview AT rajanduggal hodgkinvariantofrichterstransformationinchroniclymphocyticleukemiacllanillustrativecasereportandliteraturereview AT tinadadu hodgkinvariantofrichterstransformationinchroniclymphocyticleukemiacllanillustrativecasereportandliteraturereview AT amitagarwal hodgkinvariantofrichterstransformationinchroniclymphocyticleukemiacllanillustrativecasereportandliteraturereview AT anilhandoo hodgkinvariantofrichterstransformationinchroniclymphocyticleukemiacllanillustrativecasereportandliteraturereview |