Emily Powley¹, Mini Yue¹ , Eloise House^1
1Mater Pathology

A 69-year-old Caucasian male presented with new fevers and bone pain in the context of known Chronic Lymphocytic Leukaemia on treatment with Obinutuzumab and Venetoclax. FDG-PET imaging demonstrated multiple new PET-avid lytic lesions throughout the pelvis and vertebrae despite reduction in low avidity lymphadenopathy and resolution of hepatosplenomegaly. 

Initial CT guided left iliac bone biopsy was non-conclusive. Standard non-PET directed R PSIS bone marrow biopsy was normal. 

A week later, a second PET-directed targeted left iliac bone biopsy was obtained and a non-PET-directed L PSIS bone marrow biopsy was obtained. Joint haematopathology and anatomical pathology assessment of this bone biopsy and subsequently the bone marrow biopsy found that the targeted bone biopsy yielded peri-lesional sclerotic tissue and the bone marrow biopsy yielded lesional tissue consistent with Hodgkin lymphoma. 

Richter’s transformation to Hodgkin lymphoma is rare but described.¹ Our case highlights the patchy nature of Hodgkin lymphoma involvement in the marrow and the challenges in diagnosing Hodgkin lymphoma on core biopsies. This case highlights the need to pursue further biopsies until satisfactory tissue is obtained and the importance of collaborative input between pathology disciplines. 

 References

1.     Tsimberidou A, O’Brien S, Kantarjian H et al. Hodgkin Transformation of Chronic Lymphocytic Leukemia. Cancer 2006; 107 (6): 1294-1302.

 The above abstract is my own original work based on a clinical case that I was directly involved in. Dr Mimi Yue and Dr Eloise House assisted in the editing of the abstract.