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Hodgkin and Reed-Sternberg cells originate from germinal center B-cells. These cells tend to lose the B-cell phenotype. However, one-third of classic Hodgkin lymphoma cases express at least one B-cell marker, which can lead to difficulties in distinguishing classic Hodgkin lymphoma from B-cell lymphomas. This case report, published in Clinical Lymphoma, Myeloma, and Leukemia, analyzed a case of clinical Hodgkin lymphoma that demonstrated these unusual characteristics.

The case involved a 21-year old male. Immunohistochemistry showed an unusually strong expression of B-cell differentiation and positivity for Epstein-Barr virus (EBV). Although atypical lymphoid cells expressed classical Hodgkin phenotype CD30+/CD15+, they also showed strong CD20+ co-expression. PCR studies were negative for B- and T-cell gene rearrangements.

Lymphoma cells were strongly positive for CD30, CD15, EBV, and CD21, as well as B-cell markers CD20, Bcl-6, and MUM1. Next-generation sequencing for B-cell rearrangement was negative. Although some biomarkers indicated the presence of EBV-positive B-cell lymphoma, classic Hodgkin lymphoma was ultimately diagnosed.

Treatment began with an R-ABVD regimen, and complete regression of tumors became evident soon after. An interim PET scan was planned for further evaluation [1].

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[1] Panovska-Stavridis, I., Ridova, N., Stojanovska, S., Pivkova-Veljanovska, A., Trajkova, S., Ivanovski, M., Popova-Labachevska, M., Chevreska, L., Petrushevska, G., & Dimovski, A. J. (2021). HL-325: A case report of classic Hodgkin lymphoma with unusually abundant tumor cell expression of B-cell markers: a diagnostic dilemma and treatment challenge. Clinical Lymphoma Myeloma and Leukemia, 21, S372–S373. https://doi.org/10.1016/s2152-2650(21)01852-8

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