A Case of Classic Hodgkin Lymphoma Involving the Uterine Cervix Presenting As Vaginal Spotting.

Abstract

Classic Hodgkin lymphoma (CHL) is a clonal lymphoid neoplasm derived from B cells. CHL usually involves the lymph nodes. Although cases with extranodal involvement by CHL have been reported, the involvement of the uterine cervix by CHL is an extremely uncommon phenomenon. Herein, we report an unusual case of a 51-year-old female with nodular sclerosis CHL, diagnosed initially via right inguinal lymph node biopsy. After two cycles of chemotherapy, she presented with vaginal spotting and CT scan demonstrated a uterine cervical lesion with hypermetabolic activity. Tissue biopsy sections of the uterine cervix showed cellular infiltrate consisting of large atypical cells including many lacunar cells and occasional Reed-Sternberg cells in the background of mixed reactive cells including small- to medium-sized lymphocytes, histiocytes, plasma cells, eosinophils, and neutrophils. Immunohistochemical stains show that the large atypical cells are positive for CD30, CD15, MUM-1, and weakly positive for PAX-5. In situ hybridization for Epstein-Barr virus-encoded RNA (EBER) is negative. The morphological and immunohistochemical findings were consistent with involvement by nodular sclerosis CHL. This case demonstrates a rare presentation of CHL that may pose a diagnostic problem if its existence is not considered in the differential diagnosis. Furthermore, we reviewed the literature and only found two previous publications described uterine cervix involvement by CHL. Although it is very rare, CHL involvement should be included in the differential diagnosis and an appropriate work-up should be performed to evaluate CHL involvement of cervix when patients with CHL present with signs or symptoms suggesting a cervical lesion.