A 28-year-old female presented with bilateral cervical lymph nodes measuring 1-4cm in size for 6 months. Fine needle aspiration of the lymph nodes showed lymphoid cells, histiocytes, macrophages, and a few large cells with prominent nucleoli, possibly Reed-Sternberg cells. Numerous eosinophils and plasma cells were also seen. An initial diagnosis of malignant lymphoma such as Hodgkin's disease or anaplastic large cell lymphoma was made. Further biopsy and immunohistochemistry staining of the lymph nodes showed Hodgkin's lymphoma of the syncytial type with Langerhans cell histiocytosis. The occurrence of LCH following Hodgkin's lymphoma has been reported in less than 0

1. Case 4
28y/F , presented B/L cervical lymphnodes
of 1 – 4cm. in size of 6months duration.
FNA of lymphnodes done

13. Cytology: Cellular smear,
Lymphoid cells, histiocytes/macrophages,
A few large cells with mono/binucleate,
with prominent nucleoli, ?RS cells
Numerous eosinophils, occ. Plasma cells

14. DIAGNOSIS

15. Case 4
1. Histoplasmosis, Kimura’s Disease
2. Lymphoproliferative Diease
3. HD – Mixed Cellularaity
4. LCH
5. HD – Lypmphocytic Predominance
6. SHML with Eo
7. SHML with LCH
8. Kimura’s disease

16. IMP: Positive Malignancy –
1. Malignant lymphoma, HD/ALCL
2. Metastatic Undifferentiated
Carcinoma
Case will be reviewed after H & N workup
H & N workup was normal
FINAL IMP:
1. Malignant lymphoma, HD/ALCL
2. Histiocytic Lesion
Advised LN Bx and IHC study

20. CD1a

21. S100

22. CD30
CD15
CD30

23. CD15

24. Final diagnosis
Hodgkin Lymphoma-syncial type with LCH

25. Diagnosis of Hodgkin Lymphoma
Diagnosis of LCH

26. LCH – Systemic or single organ disease
lung, bone, lymphnode, skin, etc.
Cytology findings
Histomorphology –sinusoidal pattern + IHC
LCH+Lymphoma – Focal Langerhan Cell
Histiocytic Hyperplasia rather than LCH

27. J Res Med Sci. 2010 Jan-Feb; 15(1): 58–61.
Langerhans cell histiocytosis following Hodgkin
lymphoma: a case report from Iran
Nahid Reisi Dehkordi,a Parvin Rajabi,b Azar
Naimi,*,c and Mitra Heidarpourd
Occurrence of LCH after Hodgkin lymphoma
is seen in less than 0.3% of cases.
It can occur before, after or simultaneously
with Hodgkin Lymphoma.

28. Korean J Intern Med. Dec 2012; 27(4): 459–462.
Langerhans Cell Histiocytosis Followed by
Hodgkin's Lymphoma
IK Soo Park,1 In Keun Park,1 Eun Kyoung
Kim,1 Shin Kim,1 Sang Ryong Jeon,2 Joo Ryung
Huh,3 and Cheol Won Suh 1
This condition should be considered in the differential
diagnosis of recurrent lymphoma