Thread by @TheKarenPinto

Young male, 30’s, came with an enlarged neck node

(Well that’s all the history that I got)

#pathology #HemePath #lymphnode

The node had a vague nodular pattern with a mottled look.

There were scattered large mono, bi, multincleate cells

RS cells: CD30+ EBV+ &
CD20-,CD2-, CD45-/+
in a mixed inflammatory cell background with areas of necrosis

Easy-peasy Hodgkin lymphoma, nodular sclerosis syncytial variant

But, there was this other odd area ...

At one end of the lymph node, there were these two tiny nodules of spindle cells with extravasated RBC’s.

This is when I called the clinician to know 2 things:

1. Does the patient have any skin lesions?

2. Is the patient immunocompromised?

Turns out that the patient was HIV+ but had no skin lesions

So this is a case of Hodgkin Lymphoma with Primary Intranodal Kaposi Sarcoma.

Each arising from a different etiology (EBV & HHV8 respectively)

Besides Kaposi, HHV8 can cause
-multicenteric Castlemann disease (& it’s associated plasmablastic lymphoma)
-primary effusion lymphoma

#Remember
Just ‘cause you made one diagnosis, doesn’t mean that’s the ONLY pathology existing.

Always examine your specimen well.
#pathtip