Abstract
A 58-year-old man was immediately hospitalized in our department because of generalized lymphadenopathy and recurring fever. 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) revealed marked FDG accumulation within enlarged lymph nodes from the neck through to the inguinal region, while the axial and proximal appendicular skeleton showed diffuse and homogeneous FDG uptake. The level of hemoglobin was 12.8 g/dL, white blood cell count 6,300/μL, including 20.0% lymphocytes, and platelet count 205×103/μL. Serum albumin was 3.3 g/dL, lactate dehydrogenase 507 IU/L, aspartate aminotransferase 570 IU/L, alanine aminotransferase 419 IU/L, alkaline phosphatase 1,172 IU/mL, total bilirubin 2.3 mg/dL, ferritin 2,075 ng/mL, C-reactive protein 12.4 mg/dL, and soluble interleukin-2 receptor 6,305 U/mL. A biopsy of the left supraclavicular lymph node showed the features of the mixed cellularity subtype of classical Hodgkin lymphoma. Examination of May-Giemsa-stained smear slides of bone marrow (BM) aspirates revealed 1.4% Reed-Sternberg (RS)/Hodgkin (H) giant cells associated with monocytes/macrophages ingesting blood cells. The BM biopsy specimen contained foci of pleomorphic cellular infiltrates, and immunohistochemistry highlighted CD30-positive RS/H cells, corresponding to the “certain” category of the histopathological criteria of BM involvement. The disease responded well to ABVd chemotherapy, and the patient achieved a complete response. This case report indicates that the BM test is still mandatory to detect BM disease, and 18F-FDG PET cannot be a substitute for BM aspiration/biopsy.
