Small lymphocytic lymphoma with Reed Sternberg cells: a diagnostic dilemma.

Area of Science:

• Hematopathology
• Oncology
• Diagnostic Pathology

Background:

• Small lymphocytic lymphoma (SLL) is a low-grade non-Hodgkin lymphoma.
• Reed-Sternberg (RS) cells are characteristic of Classic Hodgkin's lymphoma (CHL).
• The presence of RS cells can complicate SLL diagnosis, potentially leading to misdiagnosis of CHL.

Observation:

• A 54-year-old male presented with cervical lymphadenopathy.
• Initial histopathological diagnosis suggested SLL with CHL.
• Biopsy review revealed SLL morphology with focal RS-like cells, but lacked the typical CHL background.

Findings:

• Immunohistochemical analysis confirmed typical SLL morphology and immunophenotype.
• The diagnosis was revised to SLL with RS-like cells, excluding CHL.
• The patient received SLL-directed treatment without disease progression over 5 years.

Implications:

• Distinguishing SLL with RS-like cells from true CHL is critical for appropriate patient management.
• This case highlights the importance of expert review in complex lymphoproliferative disorders.
• Accurate histopathological and immunophenotypic assessment prevents unnecessary CHL-specific therapies.