Hodgkin Lymphoma With Sarcoid-Like Reaction: Importance of Clinicopathological Correlation in Granulomatous Lymphadenopathy.
Ryosuke Fujita, Shiro Ono, Sota Sakamoto et al.
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Case in brief
A 63-year-old man with systemic lymphadenopathy had a cervical lymph node biopsy showing epithelioid granulomas but no identifiable neoplastic cells, prompting an initial suspicion of sarcoidosis. Evaluation found no typical sarcoidosis manifestations, including bilateral hilar lymphadenopathy, uveitis, or elevated serum angiotensin-converting enzyme. Lymphoma remained in the differential. After he developed B symptoms and substantially elevated soluble interleukin-2 receptor levels, repeat biopsy of a left supraclavicular node, 7 months after presentation, showed Reed-Sternberg-like multinucleated cells amid a sarcoid-like reaction, confirming classical Hodgkin lymphoma.
What made this case unusual
The initial biopsy was dominated by granulomas, with no identifiable neoplastic cells; the diagnostic clue emerged on repeat biopsy, which showed Reed-Sternberg-like cells within the sarcoid-like reaction.
Diagnostic / clinical pearl
When granulomatous histology does not fit the clinical picture, retain lymphoma in the differential and consider repeat biopsy if suspicion persists.