https://orcid.org/0000-0001-9983-9735
![A 23-year-old man with classic Hodgkin lymphoma (cHL) involving multiple lymph nodes, stage IIIB, International Prognostic Score 5, was treated with adriamycin, bleomycin, vinblastine, and dacarbazine, with a partial response. By the end of chemotherapy, his B symptoms resolved, but he had a new inguinal rash with pruritus. A computed tomography scan revealed bilateral inguinal bulky lymphadenopathy. A punch biopsy showed fragments of skin with multiple foci of lymphoid infiltrate (panel A; original magnification ×40, hematoxylin and eosin [H&E] stain) composed of numerous Reed-Sternberg and Hodgkin-like cells on a background of small lymphocytes and eosinophils (panel B; original magnification ×200; inset, original magnification ×1000; H&E stain). Immunohistochemical stains showed that the large neoplastic cells are positive for PAX5 (dim) (panel C; original magnification ×400), CD3 (focally) (panel D; original magnification ×1000), and CD15 and CD30 (panel E; original magnification ×40; inset, original magnification ×1000) and negative for CD2, CD4, CD5, CD7, CD8, CD20, CD45, and ALK-1. In situ hybridization for Epstein-Barr virus was negative. These histologic and immunophenotypic findings support the diagnosis of recurrent cHL. / This interesting case demonstrates skin involvement by cHL with CD3 expression. Because cHL has a 0.5% to 3% chance of involving skin and a 5% chance of expressing T cell markers, it is extremely rare to see both of these events in the same patient.](https://ash.silverchair-cdn.com/ash/content_public/journal/blood/133/5/10.1182_blood-2018-10-878058/3/m_blood878058f1.png?Expires=1765310784&Signature=2ytlY85Wn7FiEu~hatwVwIW-~~70PzeJXsicwPYDSB9WWoD-I~N9yVaD~1q-SYw8GZDFZ9TolXcYFlaGS5pZNvWi-4QdcD7DjDpecg7vJonZODiqkE0wU69YxbAfFFsq0IFkwTz3DdNigQWARgYATM2MGEOYsO3yhr10CZath6Gj5WUPiw0LqZPxdJnk9uuB8J-xU0EmDafJ4xro-X2nCidl-qJ9pVKBbrilxRv9XtbwYf-MGlU90d0Xf8Ih0AImjOIQky4PQtt9~-ag3xk1QBlVlNMi1Q0KV2zn~jgEjOnPQ6oSL7TFWc40yOVeMLWlhbzgXVDApTVxup4E9wTKmg__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA)
A 23-year-old man with classic Hodgkin lymphoma (cHL) involving multiple lymph nodes, stage IIIB, International Prognostic Score 5, was treated with adriamycin, bleomycin, vinblastine, and dacarbazine, with a partial response. By the end of chemotherapy, his B symptoms resolved, but he had a new inguinal rash with pruritus. A computed tomography scan revealed bilateral inguinal bulky lymphadenopathy. A punch biopsy showed fragments of skin with multiple foci of lymphoid infiltrate (panel A; original magnification ×40, hematoxylin and eosin [H&E] stain) composed of numerous Reed-Sternberg and Hodgkin-like cells on a background of small lymphocytes and eosinophils (panel B; original magnification ×200; inset, original magnification ×1000; H&E stain). Immunohistochemical stains showed that the large neoplastic cells are positive for PAX5 (dim) (panel C; original magnification ×400), CD3 (focally) (panel D; original magnification ×1000), and CD15 and CD30 (panel E; original magnification ×40; inset, original magnification ×1000) and negative for CD2, CD4, CD5, CD7, CD8, CD20, CD45, and ALK-1. In situ hybridization for Epstein-Barr virus was negative. These histologic and immunophenotypic findings support the diagnosis of recurrent cHL.
This interesting case demonstrates skin involvement by cHL with CD3 expression. Because cHL has a 0.5% to 3% chance of involving skin and a 5% chance of expressing T cell markers, it is extremely rare to see both of these events in the same patient.
A 23-year-old man with classic Hodgkin lymphoma (cHL) involving multiple lymph nodes, stage IIIB, International Prognostic Score 5, was treated with adriamycin, bleomycin, vinblastine, and dacarbazine, with a partial response. By the end of chemotherapy, his B symptoms resolved, but he had a new inguinal rash with pruritus. A computed tomography scan revealed bilateral inguinal bulky lymphadenopathy. A punch biopsy showed fragments of skin with multiple foci of lymphoid infiltrate (panel A; original magnification ×40, hematoxylin and eosin [H&E] stain) composed of numerous Reed-Sternberg and Hodgkin-like cells on a background of small lymphocytes and eosinophils (panel B; original magnification ×200; inset, original magnification ×1000; H&E stain). Immunohistochemical stains showed that the large neoplastic cells are positive for PAX5 (dim) (panel C; original magnification ×400), CD3 (focally) (panel D; original magnification ×1000), and CD15 and CD30 (panel E; original magnification ×40; inset, original magnification ×1000) and negative for CD2, CD4, CD5, CD7, CD8, CD20, CD45, and ALK-1. In situ hybridization for Epstein-Barr virus was negative. These histologic and immunophenotypic findings support the diagnosis of recurrent cHL.
This interesting case demonstrates skin involvement by cHL with CD3 expression. Because cHL has a 0.5% to 3% chance of involving skin and a 5% chance of expressing T cell markers, it is extremely rare to see both of these events in the same patient.
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![A 23-year-old man with classic Hodgkin lymphoma (cHL) involving multiple lymph nodes, stage IIIB, International Prognostic Score 5, was treated with adriamycin, bleomycin, vinblastine, and dacarbazine, with a partial response. By the end of chemotherapy, his B symptoms resolved, but he had a new inguinal rash with pruritus. A computed tomography scan revealed bilateral inguinal bulky lymphadenopathy. A punch biopsy showed fragments of skin with multiple foci of lymphoid infiltrate (panel A; original magnification ×40, hematoxylin and eosin [H&E] stain) composed of numerous Reed-Sternberg and Hodgkin-like cells on a background of small lymphocytes and eosinophils (panel B; original magnification ×200; inset, original magnification ×1000; H&E stain). Immunohistochemical stains showed that the large neoplastic cells are positive for PAX5 (dim) (panel C; original magnification ×400), CD3 (focally) (panel D; original magnification ×1000), and CD15 and CD30 (panel E; original magnification ×40; inset, original magnification ×1000) and negative for CD2, CD4, CD5, CD7, CD8, CD20, CD45, and ALK-1. In situ hybridization for Epstein-Barr virus was negative. These histologic and immunophenotypic findings support the diagnosis of recurrent cHL. / This interesting case demonstrates skin involvement by cHL with CD3 expression. Because cHL has a 0.5% to 3% chance of involving skin and a 5% chance of expressing T cell markers, it is extremely rare to see both of these events in the same patient.](https://ash.silverchair-cdn.com/ash/content_public/journal/blood/133/5/10.1182_blood-2018-10-878058/3/m_blood878058f1.png?Expires=1765310785&Signature=FQIIaXS7YBUD38~OqoA2Q3ir5uqT2F1O8q7Af4GFZkB10EZMxaCKVcjOLhpW5tenIjyw6pSEEZNg-vBdngDBzfPo5BHBYk2PBXwsrRaFTw3bvIwLYeZtP5kUZ77O4cyVgWu4Cerfdlg2sKScGo8ExTxDRoSjxQz0otHZDo97sqzLgKg9q6za7KVoFjZM2okyS8vbFx572F~gWuGS2zZp3sYAvccJJkZJvxyc4MrMS6AoNkiAzJ8iKhv2Q8WYN0-8mMVGMhD3FJd8yQHRILpbr8S75h5~1yiPYirvaKzmiGAo9X67JdXhdZJ-ZYIKnD8S0~TFl9GatH52Xa0JZHLIeA__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA)
