Dr Ariya S 1, Dr Elanthenral S 2, Dr Zambare Riya 3, Dr Mithun Abraham 4
- Post doctoral Fellow in Lab Hematology, Christian Medical College, Vellore, Tamil Nadu
- Professor, Department of Pathology, Christian Medical College, Vellore, Tamil Nadu
- Post doctoral Fellow in Hematopathology, Christian Medical College, Vellore, Tamil Nadu
- DM Hematologist, Department of Clinical Hematology, Christian Medical College, Vellore, Tamil Nad
Background:
Transformation of classical Hodgkin lymphoma (cHL) to diffuse large B-cell lymphoma (DLBCL) is rare, with limited reports in literature. We present a case of a young woman with nodular sclerosis cHL who progressed to DLBCL within a year of diagnosis.
Case Summary:
A 32-year-old woman from South India presented in December 2023 with cervical lymphadenopathy. PET-CT revealed a necrotic mediastinal mass (11.1×6.5×4.9 cm) and cervical/supraclavicular lymphadenopathy. Excision biopsy showed mononuclear Hodgkin and Reed-Sternberg-like cells in a polymorphous background. Immunohistochemistry was positive for CD30, CD15, and weak PAX5—diagnostic of nodular sclerosis cHL. She received six cycles of ABVD chemotherapy and 20 fractions of radiotherapy. Interim PET showed residual disease, and repeat PET at 7 months indicated progression. A second lymph node biopsy revealed a diffuse proliferation of medium to large atypical lymphoid cells positive for CD20, CD79a, LCA, MUM1 (~50%), BCL6 (~60%), and a high MIB1 index (~80%), consistent with transformation to DLBCL. The patient received salvage chemotherapy with R-ICE, achieving complete metabolic response, followed by autologous stem cell transplantation in June 2025.
Discussion:
Although rare, DLBCL transformation from cHL has been described, likely arising de novo in predisposed individuals 1. The 5-year risk of developing DLBCL in patients with cHL ranges from 1% to 2% according to various studies. 2 The immunophenotypic divergence between cHL and transformed DLBCL suggests separate clonal origins in many cases .
Conclusion:
Early recognition of treatment-resistant cHL is critical. Biopsy at relapse or progression, along with interim PET and prognostic scoring (e.g., Hasenclever Index), is essential to detect transformation and guide management.
References
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- Bellitti E, Masciopinto P, Musto P. et al. Diffuse large B cell lymphoma arising in patients with preexisting Hodgkin lymphoma. Curr Oncol. 2022;29(9):6115–24. doi:10.3390/curroncol29090480
- Mori M, Sakai T, Oka T, Moriyoshi K, Kawabata H. Development of diffuse large B-cell lymphoma serendipitously led to life-saving treatment in a patient with refractory classical Hodgkin lymphoma. Intern Med. 2025 May 1;64(9):1399–403. doi:10.2169/internalmedicine. 4334-24. Epub 2024 Sep 18. PMID: 39293977; PMCID: PMC12120223
Biography:
Dr Ariya S has completed MBBS from Dr MGR Medical University in 2014 and MD from Yenepoya Deemed to be University in 2021. She is currently pursuing fellowship in Laboratory Hematology In Christian Medical college, Vellore, Tamil Nadu. She has worked as Medical Officer in the department of Oncology, Lakeshore Hospital, Kochi, India and also has experience in teaching medical and allied health students in Medical college in India. She has special interests in diagnosis of leukemia, lymphoma and non malignant hematological conditions like hemoglobinopathies and hemophilias.
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