A Case of Hodgkin's Disease of Submandibular Lymph Nodes: Differential diagnosis from anaplastic large cell lymphoma by immunohistochemistry.

Abstract

A case of Hodgkin's disease, mixed cellularity type, similarly to the histological findings of anaplastic large cell lymphoma (ALCL) is presented. A 64-year-old man with a painless mobile swelling of left submandibular lymph nodes was referred to Nagasaki University Dental Hospital. CT, MRI and ultrasonic examination identified three enlarged lymph nodes adjacent to the submandibular gland. Histologically, proliferation of lymphoid cells with clusters of epithelioid cells, plasma cells and a few eosinophils were observed. Giant cells with one or more bizarre nuclei including distinct nucleoli were scattered or cohesively arranged in the lymph nodes. The giant cells were regarded as Hodgkin or Reed-Sternberg cells. However, cohesive arrangement and immunopositivity for EMA of the giant cells resemble the findings of ALCL. In order to discriminate between Hodgkin's disease and ALCL, immunohistochemical examination using other antibodies was performed. Finally, the lesion was diagnosed as Hodgkin's disease because of immunoreactivity for CD 15, CD 30 and EBV-LMP 1, and strong reactivity for fascin, in addition to the presence of classical Reed-Sternberg cells.