CRA67 HODGKIN’S LYMPHOMA: A CLINICAL MIMICKER AND DIAGNOSTIC CHALLENGE

Ainaa Athirah Abdullah, Shivaanand Letcheminan, Noor Izyani Zakaria, Jen Lye Wan

Hospital Selayang, Batu Caves, Malaysia

Introduction 
Hodgkin’s lymphoma (HL) is a lymphoid malignancy characterized by the presence of Hodgkin and Reed-Sternberg (HRS) cells in an inflammatory background. Granulomatous inflammation occurs in approximately 9% of HL cases, often mimicking infections like tuberculosis (TB). This diagnostic overlap can delay appropriate treatment and lead to adverse outcomes. 

Objectives 
To highlight the diagnostic challenges in distinguishing HL from tuberculous lymphadenitis and emphasize the importance of early excisional biopsy as the standard diagnostic modality in persistent lymphadenopathy. 

Methodology 
We report the case of a 14-year-old boy with persistent painless left cervical lymphadenopathy (4x4 cm) for over six weeks, with a history of close TB contact and initial absence of systemic symptoms. His chest X-ray showed apparent mediastinal widening, with a normal Lactate Dehydrogenase (LDH) level (216 U/l; reference range 0-248). Initial fine-needle aspiration cytology (FNAC) showed granulomatous inflammation but was inconclusive, with no acid-fast bacilli stain and negative TB culture. Empirical anti-tuberculous therapy (ATT) was initiated. Due to the lack of clinical improvement, a lymph node excisional biopsy was performed. 

Results 
Histopathology of the excised lymph node revealed atypical lymphoid cells and HRS cells in a mixed inflammatory background. Immunohistochemistry confirmed CD30, MUM-1, weak CD15 positivity with dim PAX5 expression, consistent with mixed cellularity HL. The patient was referred to a hematology centre and started on ABVD chemotherapy, with a good clinical response. 

Conclusion 
This case underscores the importance of considering HL in the differential diagnosis of persistent lymphadenopathy, particularly in TB-endemic areas. Reliance on FNAC alone may be insufficient for a definitive diagnosis. Early lymph node excisional biopsy is not only the standard of care but also essential for timely diagnosis and treatment.