Hodgkin's Disease Involving Bone and Adjacent Soft Tissue in Adults

Abstract

Hodgkin's disease typically presents as peripheral lymphadenopathy, with or without constitutional symptoms. Although skeletal involvement may occur during the course of the disease, bony or adjacent soft tissue masses are extremely unusual, especially as a primary presentation. With this in mind, the authors searched the files of the Armed Forces Institute of Pathology Tumor Registry for all cases that had been diagnosed as Hodgkin's disease in open bone biopsies between the years 1970 to 1992. From a total of 29, we selected 18 that represented all cases with documented clinical records and paraffin-embedded tissue blocks for immunophenotypic analysis. The majority of these predated the use of immunohistochemical markers, and the diagnosis had been made primarily on examination of hematoxylin and eosin stained slides alone. The authors reviewed the hematoxylin and eosin stained slides and performed immunophenotypic analysis for CD45RB, CD20, CD3, CD45RO, kappa and lambda light chains, CD15, CD30, vimentin, cytokeratin, epithelial membrane antigen, factor VIII, and CD57. Seven of 18 cases showed unequivocal morphologic and immunophenotypic findings consistent with Hodgkin's disease of the nonlymphocyte predominance type. There was a male:female ratio of 6:1 and an age range of 21-39 years (median, 30 years; mean 30.4 years). Of these, only two of seven patients had a prior documented history of Hodgkin's disease (stages IB and IIB). After careful morphologic examination and immunophenotypic analysis, the authors found that the remaining 11 cases represented Hodgkin's-like lesions, including atypical lymphoid infiltrates (three cases), large B-cell lymphoma (five cases), anaplastic large-cell lymphoma (one case), large T-cell lymphoma (one case), and metastatic carcinoma with a prominent desmoplastic response (one case). These cases were excluded from this study. This report describes the clinicopathologic features of Hodgkin's disease presenting as bony and adjacent soft tissue masses and confirms the potential difficulty of making this diagnosis, especially in the absence of immunohistochemical markers. Int J Surg Pathol 3(3):147-154, 1996