A case of chronic lymphocytic leukemia/small lymphocytic lymphoma with Hodgkin/Reed-Sternberg-like cells distinct from Hodgkin lymphoma

Abstract

Background : We have diagnosed a case of chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) with Hodgkin-like cells distinct from Hodgkin lymphoma.
Case : A 79-year-old man with CLL/SLL was followed for 14 years. He was suspected of a third recurrence and underwent an excisional biopsy. Imprint cell images showed Reed-Sternberg (RS) -like cells exhibiting a mirror image, polynuclear cells and Hodgkin-like cells against the background of monotonous medium-sized lymphocytes with scattered eosinophils. Histopathologically, the lymph node showed a pseudofollicular pattern. The immunohistochemical study showed that most of the small to medium sized lymphocytes were positive for CD5, CD20, and CD23. Hodgkin/Reed-Sternberg (HRS) -like cells were positive for CD30, CD15, PAX-5, MUM-1, and Epstein-Barr virus encoded small RNA in situ hybridization (EBER-ISH). The histological diagnosis was CLL/SLL with Hodgkin-like cells.
Conclusion : Most cases of Richiter syndrome develop to diffuse large B-cell lymphoma (DLBCL). We should check for the appearance of HRS-like cells when following CLL/SLL patients.