case_images: PMC8795608_01
case_images: Histopathology and immunohistochemistry of the lymph nodes of this patient. In October 2019, (A) HE staining revealed nodular sclerosis classic Hodgkin lymphoma (10x), IHC staining showed that lymphoma cells were positive for (B) CD30 (20x), (C) PAX-5 (20x). In May 2020, (D) HE staining revealed nodular sclerosis classic Hodgkin lymphoma (10x), IHC staining showed that lymphoma cells were positive for (E) CD30 (20x), (F) PAX-5 (20x). In December 2020, (G) HE staining revealed lymphoid tissue had a proliferative change (10x), IHC staining showed that lymphoma cells were negative for (H) CD30 (20x), and positive for (I) PAX-5 (20x).
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case_images: The lymph node on the right side of the neck was biopsied, and the pathology suggested nodular sclerosis classic Hodgkin lymphoma ( Figure 1A ), a subtype of classic Hodgkin lymphoma. Immunohistochemistry (IHC) results of CD30 (+) (  Figure 1B ), CD15 (+), PAX5 (+) ( Figure 1C ), Bcl-2 (+), MUM-1 (+), Bcl-6 (partial +), CD21 (FDC+), Ki-67 (+, 60%), PD-1 (small lymphocytes +, 20%), CD3, CD5, CD7, CD20, CD45, anaplastic lymphoma kinase (ALK), and EMA were all negative. A biopsy of the left axillary lymph node was undertaken, and the pathology indicated classic Hodgkin lymphoma, nodular sclerosis type ( Figure 1D ). CD30 (+) ( Figure 1E ), CD15 (+), PAX-5 (+ weak) ( Figure 1F ), Bcl-2 (+), MUM1 (+), CD21 (FDc+), Ki-67 (+80%), Bcl-6, CD3, CD5, CD7, CD20, CD45, ALK, EMA, and EBER were all negative. Considering the disease progression of the patient, she received tislelizumab (200 mg Q3W) for 4 cycles. A biopsy of the left axillary lymph node showed that lymphoid tissues exhibited a proliferative change ( Figure 1G ). The results of IHC indicated that CD30 (-) ( Figure 1H ), CD3 (+), CD20 (+), Ki-67 (around 5%+), CD5 (+), CD10 (germinal center +), Bcl-2 (+), Bcl-6 (germinal center +), MUM1 (scattered W+), PAX-5 (+) ( Figure 1I ), CD21 (FDC+), VD23 (FDC+), cyclinD1c-Myc, ALK and EBER were all negative.
case_images: Tumor assessment during treatment by PET. (A) In October 2019, the size of the left axillary lymph node was 3.1 x 2.2 cm, and maximum standard uptake value (SUVmax) from 18F-FDG is 7.0. (B) In December 2019, the size of the left axillary lymph node was 1.51 x 0.84 cm, SUVmax is 2.0. (C) In May 2020, the left axillary lymph node was1.69 x 1.69 cm, and SUVmax is 5.9. (D) In August 2020, the left axillary lymph node was 1.5 cm, and SUVmax is 2.1. (E) In January 2021, PET/CT showed the SUVmax is 2.1.
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case_images: In October 2019, primary positron emission tomography-computed tomography (PET/CT) showed that there were multiple enlarged lymph nodes in the bilateral neck, bilateral inguen, and left axilla, and that the size of the left axillary lymph node was 3.1 x 2.2 cm ( Figure 2 ). IIIA, and she subsequently received ABVD chemotherapy (a combination of doxorubicin, bleomycin, vinblastine, and dacarbazine) for 2 cycles. In December 2019, the secondary PET/CT showed that the size of the left axillary lymph node was significantly smaller and that glucose metabolism of FDG was reduced ( Figure 2 ). In May 2020, a tertiary PET/CT examination showed that the left axillary lymph node was larger and that metabolism was increased ( Figure 2 ), following local recurrence after treatment. In August 2020, the quaternary PET/CT revealed that multiple lymph nodes in the bilateral neck, the left clavicle and left axilla area were slightly enlarged and exhibited mildly increased metabolic activity ( Figure 2 ) suggesting that there was still residual tumor activity after targeted therapy. In January 2021, the quinary PET/CT scans showed there was no obvious increase in glucose metabolism of FDG in the area of the lymph nodes, after the lesion had shrunk and tumor activity inhibited( Figure 2 ).
case_images: Changes of lymph nodes evaluated by CT. (A) In September 2020. (B) In October 2020. (C) In December 2020.
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case_images: Table 1 ). The US and CT scans showed that multiple lymph nodes were notably enlarged all over the body compared to before treatment ( Figure 3 ).
case_images: Clinical course of the patient. US, ultrasound; LN, lymph node.
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case_images: The clinical course of the patient is shown in  Figure 4 .