A case of the syncytial variant of classical Hodgkin lymphoma-nodular sclerosis subtype

Background : The syncytial variant is a rare variant of classical Hodgkin lymphoma (CHL)-nodular sclerosis subtype. Histologically, this variant shows diffuse or nodular proliferation of large neoplastic cells, therefore, careful attention should be paid to differentiate it from metastatic carcinoma. Case : The case was that of a female in her 90’s who presented with right axillary lymph node swelling. Although metastatic breast cancer was suspected, imaging studies did not show any mass lesion in either breast. Fine needle aspiration cytology and needle biopsy of the axillary lymph node did not reveal any definite evidence of neoplastic disease. Imprint cytology of the dissected lymph node showed solitary or clustered large atypical cells with prominent nucleoli, mimicking epithelial tumor. The final histologic diagnosis was the syncytial variant of CHL-nodular sclerosis subtype. Immunohistochemistry showed the following results : cytokeratin (−), LCA (−), CD30 (+), and CD15 (+). Epstein-Barr virus mRNA was detected in the tumor cells. Conclusion : Cytopathologically, the syncytial variant of CHL-nodular sclerosis subtype shows an abundance of large neoplastic cells often occurring in cohesive clusters like epithelial tumor cells. It should be borne in mind in lymph node cytology that this disease might mimic metastatic carcinoma.