Epstein-Barr virus-positive Hodgkin lymphoma-like earlobe lymphoid infiltrate: case report

Hodgkin lymphoma (HL) is a malignancy of the lymph system usually occurring on the lymph nodes. A 57-year-old Japanese woman presented with the chief complaint of an enlarging tumor of the left ear. An excisional biopsy was taken, and histological examination showed a mixed infiltration of cells, including Reed-Sternberg cells and their mononuclear forms against a background of small lymphocytes. Reed-Sternberg cells were CD15, CD20, CD30, Ki-67, MUM-1, CD45, EMA, and Epstein-Barr virus-encoded small RNA was detected by in situ hybridization. We diagnosed this tumor as a skin infiltration with a lymphocyte-rich classical HL pattern. Skin involvement of HL is most often a secondary phenomenon representing a rare late manifestation of disease dissemination; however, we could not detect any evidence of systemic lesion for 6 months after the initial presentation. A case of HL only involving the skin was reported by several past reports, which termed it primary cutaneous HL. But, it is still controversial whether HL initially occurs on the skin because a diagnostic gray zone exists between HL, some non-HL entities, and nonneoplastic lymphoid infiltrates. Clinical and histological features of this case suggest that the skin will become a primary site of HL.