Classical Hodgkin lymphoma arising from heterotopic Warthin's tumor in the cervical lymph node: A case report

Abstract

Heterotopic Warthin's tumor (WT) arising from the cervical lymph nodes is uncommon and WT presenting concomitantly with classical Hodgkin's lymphoma has only been previously reported three times in English literature. The current study presents an unusual case of classical Hodgkin lymphoma (CHL) involving the heterotopic WT in a 59-year-old male. Histopathologic examination revealied a WT with extensive expansion of mixed-cellularity CHL in a lymph node in the right of the neck. Clinical staging was determined as stage IA disease. The patient received four courses of chemotherapy and local consolidative radiotherapy, no evidence of disseminated lymphoma was observed over the 6-month follow-up. To the best of our knowledge, this is the first well documented collision tumor between CHL and heterotopic WT of the cervical lymph nodes. The present case also expands the anatomical site of malignant lymphomas associated with WT.

Keywords: Hodgkin lymphoma; Warthin's tumor; classical; collision tumor; heterotopic.

Figure 1.

Ultrasound sonography examination revealed two lymph nodes, 1.5×0.5 and 1.3×1.2 cm in size with no clear boundary between the cortex and medulla below the sternocleidomastoid muscle of the right neck.

Figure 2.

Histological examination revealed the presence of a Warthin's tumor, composed of inner columnar eosinophilic cells surrounded by smaller basal cells (A-D); Classic RS cells and other types of RS cells are easily observed in the mixed background (B-D). Magnification (A) ×5, (B) ×100, (C) ×200 and (D) ×400. RS, Reed-Sternberg.

Figure 3.

Immunohistochemical analysis revealed the RS cells were strongly positive for (A) CD30 and (B) CD15 and weakly positive for (C) PAX5. (D) Epstein-Barr virus encoded RNA in situ hybridization was also positive in RS cells. Magnification, ×400. CD, cluster of differentiation; PAX5, paired box protein Pax-5; RS, Reed-Sternberg.