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Cerebrospinal fluid infiltration in Hodgkin lymphoma: a case report
Man Updesh Singh Sachdeva1, Vikas Suri, Pankaj Malhotra
1Department of Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Insights
Central nervous system involvement by Hodgkin lymphoma is rare, especially in cerebrospinal fluid (CSF). This case highlights CSF cytology
Area of Science:
- Neurology
- Oncology
- Hematology
Background:
- Hodgkin lymphoma rarely involves the central nervous system (CNS).
- Cerebrospinal fluid (CSF) involvement is an even rarer manifestation of Hodgkin lymphoma.
- This report details a case of Hodgkin lymphoma with concurrent CSF infiltration during chemotherapy.
Observation:
- A 45-year-old woman with Hodgkin lymphoma presented with headache during chemotherapy.
- Cerebrospinal fluid (CSF) examination revealed eosinophilic pleocytosis and atypical mononuclear cells consistent with Hodgkin cells.
- Reed-Sternberg cells were notably absent in the CSF cytology.
Findings:
- Cerebrospinal fluid (CSF) cytology is a valuable diagnostic tool for detecting CNS involvement in Hodgkin lymphoma.
- Diagnosis of CNS involvement may precede radiographic findings on MRI or CT scans.
- Intrathecal methotrexate showed a reduction in CSF cellular infiltrate.
Implications:
- Early diagnosis of CNS involvement in Hodgkin lymphoma is crucial for timely intervention.
- CSF cytology offers a sensitive method for detecting leptomeningeal disease.
- This case underscores the importance of CSF analysis in patients with neurological symptoms during lymphoma treatment.
Background:
Central nervous system (CNS) involvement by Hodgkin lympboma is a rare event. Involvement of the cerebrospinal fluid (CSF) in such cases is even more uncommon. We report a case of Hodgkin lymphoma in which the patient developed infiltration of the CSF while on chemotherapy.
Case:
A 45-year-old woman was diagnosed with Hodgkin lymphoma by fine needle aspiration and subsequent biopsy of the cervical lymph node. She complained of headache during the course of chemotherapy, for which CSF examination was undertaken. Cytocentrifuge sediment of the CSF revealed marked eosinophilic pleocytosis, accompanied by scattered monocytes, polymorpbs, lymphocytes, plasma cells and histiocytes. An occasional large mononudlear cell with a large, round nucleus and prominent irregular nucleolus with a moderate amount of basophilic cytoplasm conformning to the morphology of Hodgkin's cells was noted. Binucleated Reed-Sternberg cells were not seen. Following intratbecal methotrexate, a reduction in the cellular infiltrate was observed.
Conclusion:
CSF cytology is important for the diagnosis of CNS involvement by Hodgkin lymphoma and may be positive before lesions can be visualized by magnetic resonance imaging or computed tomograpby scans.
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