case_images: PMC7506053_01
case_images: Tumor in the lateral part of the left temporal lobe and the cerebellum in magnetic resonance imaging (MRI) scans.
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case_images: PMC7506053_01_fneur-11-00963-g0001.jpg
case_images: F1
case_images: The magnetic resonance imaging (MRI) scans of the head revealed the tumor present in the lateral part of the left temporal lobe and the cerebellum (Figure 1).
case_images: Necrotic area of the lung surrounded by atypical lymphoid cells (A,B); dense lymphocytic infiltration of the wall of the blood vessel (C); and positive immunostaining for CD20 (D), CD30 (E), and EBV/LMP1 (F) corresponding to grade 1 lymphomatoid granulomatosis (magnification A-10x; B,D-F-20x; C-40x).
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case_images: PMC7506053_01_fneur-11-00963-g0002.jpg
case_images: F2
case_images: However, on further evaluation of the formalin-fixed paraffin-embedded sections, we observed many irregular necrotic areas, as well as fibrinous exudate with many macrophages and a few neutrophils in the alveoli (Figures 2A-C). T cells (CD3+) were found (Figures 2D-F). The final diagnosis was changed to grade 1 LYG with lung involvement.
case_images: Dense infiltration of the brain composed of Reed-Sternberg cells, small lymphocytes, and macrophages (A-C) corresponding to the classical Hodgkin lymphoma of the central nervous system, mixed cellularity (MCcHL), and positive immunostaining for CD30 (D), CD20 (E), and EBV/LMP1 (F) in Reed-Sternberg cells (objective magnification A-10x; B,C-40x; D-F-20x).
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case_images: PMC7506053_01_fneur-11-00963-g0003.jpg
case_images: F3
case_images: T cells (CD3+) and macrophages (CD68+) with dispersed giant cells of Reed-Sternberg morphology were observed (Figures 3A-C). The following immunophenotype of the aforementioned cells were revealed: CD45 (+, weaker than in T cells), CD30 (+, strong cytoplasmic and membranous), CD15 (+/-, weak cytoplasmic and in Golgi system in some cells), CD20 (+, membranous, weaker than in B cells), OCT (+/-, strong nuclear on the majority of the cells), BOB1 (-/+, trace in single cells), CD10 (-), Bcl6 (-), ALK1 (-), CD3 (-), S100 (-), and CD1a (-). Prognostic markers on Hodgkin and Reed-Sternberg (HRS) cells were as follows: Bcl2 (+, cytoplasmic, weaker than T cells), Ki67 (+, strong in almost all HRS cells), and CD68 (+++) in many concomitant macrophages (category 3) (Figures 3D,E). Classical Hodgkin lymphoma (cHL) of the CNS, mixed cellularity subtype (MCcHL) was diagnosed. Correlation between the reactivation of Epstein-Barr virus (EBV) with the positive EBV/LMP1 immunostaining was emphasized (Figure 3F).