https://orcid.org/0000-0003-3389-2618
![A 40-year-old woman was diagnosed with classic Hodgkin lymphoma (CHL) in 2016. At that time, the neoplasm was positive for CD30 as expected for a CHL. The patient was treated with 6 cycles of ABVD (Adriamycin [doxorubicin], bleomycin, vinblastine, dacarbazine) without radiation. The tumor relapsed in 2017 and was treated with nivolumab and later brentuximab vedotin (BV) and is receiving chimeric antigen receptor T cells (CAR-T) against CD30 since March 2021. Recent positron emission tomography scan showed chest wall/axillary lymph nodes with a standardized uptake value of 8.1 (arrow; panel A). Histologic section revealed few scattered, large, atypical cells with prominent eosinophilic nucleoli in a background rich in small lymphocytes (panels B-C; hematoxylin-eosin stain, objective magnification ×100) with areas of fibrosis. The neoplastic cells were negative to weakly positive for CD30 (panel D; immunohistochemical stain [IHC], objective magnification ×100), weakly positive positive for PAX-5 (panel E; IHC, objective magnification ×100), and positive for CD15 (panel F; IHC, objective magnification ×100). They were negative for CD20 and CD45. More sensitive immunofluorescence testing using tyramide signal amplification (TSA) confirmed low-level expression of CD30 in tumor cells (panels G-H; objective magnification ×40).](https://ash.silverchair-cdn.com/ash/content_public/journal/blood/139/6/10.1182_blood.2021013881/3/m_bloodbld2021013881f1.png?Expires=1759319910&Signature=evK~Ioo3jduGKuRPV3rjS77BsB3JFyrMEssE2rm8x9g2YpUIehofD81SnnZFx0MRLyHRgowELDXpxpKVKa0bfB1XmdAWCd27rg6XerpwatumnD8ugnI9wu2HpxAta11v3gBC7AEDXyCgNGHvwe90hjnuawrWAD6IREqnhIMOWRx-nE-FNI2Mz2ABMWELXXq-GbMNVgkFtq5KBOKPRTek49qKokUlla-GkADSfKhG86hd0BlP5p4l7kVSZBZVuLGt~N8QSngr1CDcNLMlZQ7FX4swqmjbSznLUGYJ2vgqvDIAuHD0sUAmxdXfa1Rn2XPAWQDDP7dZGnAnvL0vLMSsng__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA)
A 40-year-old woman was diagnosed with classic Hodgkin lymphoma (CHL) in 2016. At that time, the neoplasm was positive for CD30 as expected for a CHL. The patient was treated with 6 cycles of ABVD (Adriamycin [doxorubicin], bleomycin, vinblastine, dacarbazine) without radiation. The tumor relapsed in 2017 and was treated with nivolumab and later brentuximab vedotin (BV) and is receiving chimeric antigen receptor T cells (CAR-T) against CD30 since March 2021. Recent positron emission tomography scan showed chest wall/axillary lymph nodes with a standardized uptake value of 8.1 (arrow; panel A). Histologic section revealed few scattered, large, atypical cells with prominent eosinophilic nucleoli in a background rich in small lymphocytes (panels B-C; hematoxylin-eosin stain, objective magnification ×100) with areas of fibrosis. The neoplastic cells were negative to weakly positive for CD30 (panel D; immunohistochemical stain [IHC], objective magnification ×100), weakly positive positive for PAX-5 (panel E; IHC, objective magnification ×100), and positive for CD15 (panel F; IHC, objective magnification ×100). They were negative for CD20 and CD45. More sensitive immunofluorescence testing using tyramide signal amplification (TSA) confirmed low-level expression of CD30 in tumor cells (panels G-H; objective magnification ×40).
To the best of our knowledge, decreased expression of CD30 in CHL after BV or CAR-T treatment has not been reported. Negative to very weak positive CD30 by IHC and background rich in small lymphocytes created diagnostic difficulties; previous history of CHL, the presence of atypical large cells positive for PAX-5 and CD15 but negative for CD45 by IHC and positive for CD30 by TSA helped to establish the diagnosis.
A 40-year-old woman was diagnosed with classic Hodgkin lymphoma (CHL) in 2016. At that time, the neoplasm was positive for CD30 as expected for a CHL. The patient was treated with 6 cycles of ABVD (Adriamycin [doxorubicin], bleomycin, vinblastine, dacarbazine) without radiation. The tumor relapsed in 2017 and was treated with nivolumab and later brentuximab vedotin (BV) and is receiving chimeric antigen receptor T cells (CAR-T) against CD30 since March 2021. Recent positron emission tomography scan showed chest wall/axillary lymph nodes with a standardized uptake value of 8.1 (arrow; panel A). Histologic section revealed few scattered, large, atypical cells with prominent eosinophilic nucleoli in a background rich in small lymphocytes (panels B-C; hematoxylin-eosin stain, objective magnification ×100) with areas of fibrosis. The neoplastic cells were negative to weakly positive for CD30 (panel D; immunohistochemical stain [IHC], objective magnification ×100), weakly positive positive for PAX-5 (panel E; IHC, objective magnification ×100), and positive for CD15 (panel F; IHC, objective magnification ×100). They were negative for CD20 and CD45. More sensitive immunofluorescence testing using tyramide signal amplification (TSA) confirmed low-level expression of CD30 in tumor cells (panels G-H; objective magnification ×40).
To the best of our knowledge, decreased expression of CD30 in CHL after BV or CAR-T treatment has not been reported. Negative to very weak positive CD30 by IHC and background rich in small lymphocytes created diagnostic difficulties; previous history of CHL, the presence of atypical large cells positive for PAX-5 and CD15 but negative for CD45 by IHC and positive for CD30 by TSA helped to establish the diagnosis.
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