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Primary gastric Hodgkin's lymphoma.

Hossain FS, Koak Y, Khan FH - World J Surg Oncol (2007)

Bottom Line: Postoperatively histology and immunohistochemistry failed to confirm a diagnosis.Our case illustrates the significant difficulties in achieving a rare diagnosis of primary Hodgkin's lymphoma of the stomach.While immunohistochemistry is widely employed in aiding the evaluation of such cases, one should be wary of the considerable overlap in differentiating between Hodgkin's and non-Hodgkin's disease entities using this technique.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, Queen Mary's Sidcup Hospital, Frognal Avenue, Sidcup, Kent, DA14 6LT, UK. f.hossain@doctors.org.uk

ABSTRACT

Background: Primary Hodgkin's disease of the stomach is an extremely rare entity. Nearly all cases of primary gastric lymphoma are of the non-Hodgkin's variety. Diagnoses in such cases are difficult due to considerable histological similarities between the 2 disease entities.

Case presentation: We report the case of a 77 year old lady with a 1 year history of weight loss and poor appetite. Physical examination was unremarkable. Subsequent multiple upper GI endoscopies revealed a large malignant looking ulcer which was deemed to be histologically benign. Following CT imaging the patient underwent a radical gastrectomy. Postoperatively histology and immunohistochemistry failed to confirm a diagnosis. As such a second opinion was sought. Employing an extended array of immunohistological staining a diagnosis of 'Classical Hodgkin's' disease of the stomach was achieved.

Conclusion: Our case illustrates the significant difficulties in achieving a rare diagnosis of primary Hodgkin's lymphoma of the stomach. The non-specific nature of symptoms and a lack of histological features make a preoperative diagnosis extremely difficult. While immunohistochemistry is widely employed in aiding the evaluation of such cases, one should be wary of the considerable overlap in differentiating between Hodgkin's and non-Hodgkin's disease entities using this technique.

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Related in: MedlinePlus

Photomicrograph showing mononuclear and bi-lobed variants of Reed-Sternberg cells as in 'Classical Hodgkins's' disease on a background of ulcerated gastric mucosa.
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Figure 2: Photomicrograph showing mononuclear and bi-lobed variants of Reed-Sternberg cells as in 'Classical Hodgkins's' disease on a background of ulcerated gastric mucosa.

Mentions: Initial histopathological examination of the resected stomach from the ulcer site at the local hospital showed abundant lymphocytic infiltration composed of lymphocytes and eosinophils. Immunohistochemical staining showed numerous CD30 positive large cells (Figure 1). A preliminary diagnosis of anaplastic large cell lymphoma was considered. Specimens were sent for a second opinion to University College London Hospital. A polymorphous lymphoid infiltrate was identified including scattered large cells showing Reed-Sternberg morphology (Figure 2). A panel of immunohistochemical markers were stained for. A predominant expression of CD30, CD15 and EBV-LMP1 were seen in the cells while being weakly positive for CD20. Staining for CD79a, CD3, bcl-2 and bcl-6 were negative. A diagnosis of "Classical Hodgkin's disease of the stomach" was made.


Primary gastric Hodgkin's lymphoma.

Hossain FS, Koak Y, Khan FH - World J Surg Oncol (2007)

Photomicrograph showing mononuclear and bi-lobed variants of Reed-Sternberg cells as in 'Classical Hodgkins's' disease on a background of ulcerated gastric mucosa.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2117016&req=5

Figure 2: Photomicrograph showing mononuclear and bi-lobed variants of Reed-Sternberg cells as in 'Classical Hodgkins's' disease on a background of ulcerated gastric mucosa.
Mentions: Initial histopathological examination of the resected stomach from the ulcer site at the local hospital showed abundant lymphocytic infiltration composed of lymphocytes and eosinophils. Immunohistochemical staining showed numerous CD30 positive large cells (Figure 1). A preliminary diagnosis of anaplastic large cell lymphoma was considered. Specimens were sent for a second opinion to University College London Hospital. A polymorphous lymphoid infiltrate was identified including scattered large cells showing Reed-Sternberg morphology (Figure 2). A panel of immunohistochemical markers were stained for. A predominant expression of CD30, CD15 and EBV-LMP1 were seen in the cells while being weakly positive for CD20. Staining for CD79a, CD3, bcl-2 and bcl-6 were negative. A diagnosis of "Classical Hodgkin's disease of the stomach" was made.

Bottom Line: Postoperatively histology and immunohistochemistry failed to confirm a diagnosis.Our case illustrates the significant difficulties in achieving a rare diagnosis of primary Hodgkin's lymphoma of the stomach.While immunohistochemistry is widely employed in aiding the evaluation of such cases, one should be wary of the considerable overlap in differentiating between Hodgkin's and non-Hodgkin's disease entities using this technique.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, Queen Mary's Sidcup Hospital, Frognal Avenue, Sidcup, Kent, DA14 6LT, UK. f.hossain@doctors.org.uk

ABSTRACT

Background: Primary Hodgkin's disease of the stomach is an extremely rare entity. Nearly all cases of primary gastric lymphoma are of the non-Hodgkin's variety. Diagnoses in such cases are difficult due to considerable histological similarities between the 2 disease entities.

Case presentation: We report the case of a 77 year old lady with a 1 year history of weight loss and poor appetite. Physical examination was unremarkable. Subsequent multiple upper GI endoscopies revealed a large malignant looking ulcer which was deemed to be histologically benign. Following CT imaging the patient underwent a radical gastrectomy. Postoperatively histology and immunohistochemistry failed to confirm a diagnosis. As such a second opinion was sought. Employing an extended array of immunohistological staining a diagnosis of 'Classical Hodgkin's' disease of the stomach was achieved.

Conclusion: Our case illustrates the significant difficulties in achieving a rare diagnosis of primary Hodgkin's lymphoma of the stomach. The non-specific nature of symptoms and a lack of histological features make a preoperative diagnosis extremely difficult. While immunohistochemistry is widely employed in aiding the evaluation of such cases, one should be wary of the considerable overlap in differentiating between Hodgkin's and non-Hodgkin's disease entities using this technique.

Show MeSH
Related in: MedlinePlus