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Case history:

A 37-year-old male with left neck mass. No significant medical history. Additional stains: ALK-, CD30, CD3-. 

What is the diagnosis?

  1. Anaplastic large T-cell lymphoma
  2. Lymphocyte depleted Classical Hodgkin lymphoma
  3. DLBCL, anaplastic variant
  4. Peripheral T-cell lymphoma
Answer: "B." Lymphocyte-depleted classical Hodgkin lymphoma (LDCHL)
LDCHL morphologically can present like a high-grade sarcoma and might pose a diagnostic challenge. CHL can rarely express T-cell antigens including CD8 and CD4. It is important to differentiate from ALCL using proper phenotyping. The large lymphoma cells in the current case were positive for CD30, PAX5(weak), CD15 (mostly), CD4, and MUM1. The negative stains were CD45, CD2, CD3, CD43, CD20, CD8, CD5, CD79a. Also, the patient was reported to have immunosuppressive therapy history. 

Case contributed by Deniz Peker, M.D., Associate Professor, Anatomic Pathology, UAB Department of Pathology