A lymph node biopsy of right neck was performed in May 1998, which showed effaced normal architecture and clusters and sheets of Reed-Sternberg cells and variants (Figures 3 and 4). Immunoperoxidase stains performed on paraffin sections showed that the large cells were negative for common leukocyte antigen and epithelial membrane antigen, but positive for CD 15 (Leu M1) (Figure 5), CD 30 (Ki 1) (Figure 6) and fascin. There was a mononuclear infiltrate of CD45RO T cells (Figure 7) and CD20 (L26) positive B cells, with a few tumor cells expressing CD20 (Figure 8). A diagnosis of Hodgkin's Disease, nodular sclerosing, syncytial variant was rendered. Flow cytometric studies were found to be compatible with this diagnosis.
The patient had an open biopsy of the right parietal mass. The mass was closely apposed to the dura. The exterior of the mass was surprisingly firm. Microscopic sections of this external area revealed tissue consistent with a capsule, with macrophages, lymphocytes and vascular proliferation. Microscopic sections of the softer, interior portion of the mass revealed a mixture of reactive brain, necrosis, and markedly atypical cells admixed with lymphocytes, eosinophils and histiocytes (Figure 9). The malignant cells had abundant eosinophilic cytoplasm, with large nuclei and macronucleoli. Atypical mitoses were common. There were occasional multinucleated tumor cells, as well as apoptotic cells (Figure 10). Occasional tumor cells were binucleate, with prominent nucleoli (Figure 11). Immunoperoxidase staining revealed the tumor cells to have positive cytoplasmic staining for CD 15 (Figure 12) and CD 30 (Figure 13); some tumor cells were also positive for CD 20 (Figure 14). The accompanying mononuclear infiltrate consisted mostly of CD 45RO positive small T-lymphocytes (Figure 15) and a few CD 20-positive B-lymphocytes. The tumor cells were compared with that in the previous lymph node biopsy and they appeared morphologically and immunophenotypically similar.
DIAGNOSIS AND DISCUSSION