https://orcid.org/0000-0003-3389-2618
![A 40-year-old woman was diagnosed with classic Hodgkin lymphoma (CHL) in 2016. At that time, the neoplasm was positive for CD30 as expected for a CHL. The patient was treated with 6 cycles of ABVD (Adriamycin [doxorubicin], bleomycin, vinblastine, dacarbazine) without radiation. The tumor relapsed in 2017 and was treated with nivolumab and later brentuximab vedotin (BV) and is receiving chimeric antigen receptor T cells (CAR-T) against CD30 since March 2021. Recent positron emission tomography scan showed chest wall/axillary lymph nodes with a standardized uptake value of 8.1 (arrow; panel A). Histologic section revealed few scattered, large, atypical cells with prominent eosinophilic nucleoli in a background rich in small lymphocytes (panels B-C; hematoxylin-eosin stain, objective magnification ×100) with areas of fibrosis. The neoplastic cells were negative to weakly positive for CD30 (panel D; immunohistochemical stain [IHC], objective magnification ×100), weakly positive positive for PAX-5 (panel E; IHC, objective magnification ×100), and positive for CD15 (panel F; IHC, objective magnification ×100). They were negative for CD20 and CD45. More sensitive immunofluorescence testing using tyramide signal amplification (TSA) confirmed low-level expression of CD30 in tumor cells (panels G-H; objective magnification ×40).](https://ash.silverchair-cdn.com/ash/content_public/journal/blood/139/6/10.1182_blood.2021013881/3/m_bloodbld2021013881f1.png?Expires=1769526292&Signature=1erV27M7228LFgttVS8t1ppRLb9yk2s8VWYnjP~aJQmfHRsG1lVWdIGHmTHFQNnWT-d8iNNB25NaqxoipJPWlO6oFCem8eKsr1ehiVstxHOymLQq2opygH2DS~yEv1F84cv3qVG7JKX0FdGIBl2NIHR-6n1HbDD~Qg2K1ZgX1-jFTZlqHUAC55okgTTpmZ2VzI3bV-VCc7vc7zTRXlq76ocX81jh4Dpwxc4pLGohs8CZpyA4dZgb-VT5fZUAna9nT8JBZ6plRNaCBxXRcmbtXDtCLutXTkKg5zeW38O25-lsG3DaKKijL4rAPYBhdGXQ6t7LUOTsWPhX21RW--8bNg__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA)
A 40-year-old woman was diagnosed with classic Hodgkin lymphoma (CHL) in 2016. At that time, the neoplasm was positive for CD30 as expected for a CHL. The patient was treated with 6 cycles of ABVD (Adriamycin [doxorubicin], bleomycin, vinblastine, dacarbazine) without radiation. The tumor relapsed in 2017 and was treated with nivolumab and later brentuximab vedotin (BV) and is receiving chimeric antigen receptor T cells (CAR-T) against CD30 since March 2021. Recent positron emission tomography scan showed chest wall/axillary lymph nodes with a standardized uptake value of 8.1 (arrow; panel A). Histologic section revealed few scattered, large, atypical cells with prominent eosinophilic nucleoli in a background rich in small lymphocytes (panels B-C; hematoxylin-eosin stain, objective magnification ×100) with areas of fibrosis. The neoplastic cells were negative to weakly positive for CD30 (panel D; immunohistochemical stain [IHC], objective magnification ×100), weakly positive positive for PAX-5 (panel E; IHC, objective magnification ×100), and positive for CD15 (panel F; IHC, objective magnification ×100). They were negative for CD20 and CD45. More sensitive immunofluorescence testing using tyramide signal amplification (TSA) confirmed low-level expression of CD30 in tumor cells (panels G-H; objective magnification ×40).
To the best of our knowledge, decreased expression of CD30 in CHL after BV or CAR-T treatment has not been reported. Negative to very weak positive CD30 by IHC and background rich in small lymphocytes created diagnostic difficulties; previous history of CHL, the presence of atypical large cells positive for PAX-5 and CD15 but negative for CD45 by IHC and positive for CD30 by TSA helped to establish the diagnosis.
A 40-year-old woman was diagnosed with classic Hodgkin lymphoma (CHL) in 2016. At that time, the neoplasm was positive for CD30 as expected for a CHL. The patient was treated with 6 cycles of ABVD (Adriamycin [doxorubicin], bleomycin, vinblastine, dacarbazine) without radiation. The tumor relapsed in 2017 and was treated with nivolumab and later brentuximab vedotin (BV) and is receiving chimeric antigen receptor T cells (CAR-T) against CD30 since March 2021. Recent positron emission tomography scan showed chest wall/axillary lymph nodes with a standardized uptake value of 8.1 (arrow; panel A). Histologic section revealed few scattered, large, atypical cells with prominent eosinophilic nucleoli in a background rich in small lymphocytes (panels B-C; hematoxylin-eosin stain, objective magnification ×100) with areas of fibrosis. The neoplastic cells were negative to weakly positive for CD30 (panel D; immunohistochemical stain [IHC], objective magnification ×100), weakly positive positive for PAX-5 (panel E; IHC, objective magnification ×100), and positive for CD15 (panel F; IHC, objective magnification ×100). They were negative for CD20 and CD45. More sensitive immunofluorescence testing using tyramide signal amplification (TSA) confirmed low-level expression of CD30 in tumor cells (panels G-H; objective magnification ×40).
To the best of our knowledge, decreased expression of CD30 in CHL after BV or CAR-T treatment has not been reported. Negative to very weak positive CD30 by IHC and background rich in small lymphocytes created diagnostic difficulties; previous history of CHL, the presence of atypical large cells positive for PAX-5 and CD15 but negative for CD45 by IHC and positive for CD30 by TSA helped to establish the diagnosis.
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![A 40-year-old woman was diagnosed with classic Hodgkin lymphoma (CHL) in 2016. At that time, the neoplasm was positive for CD30 as expected for a CHL. The patient was treated with 6 cycles of ABVD (Adriamycin [doxorubicin], bleomycin, vinblastine, dacarbazine) without radiation. The tumor relapsed in 2017 and was treated with nivolumab and later brentuximab vedotin (BV) and is receiving chimeric antigen receptor T cells (CAR-T) against CD30 since March 2021. Recent positron emission tomography scan showed chest wall/axillary lymph nodes with a standardized uptake value of 8.1 (arrow; panel A). Histologic section revealed few scattered, large, atypical cells with prominent eosinophilic nucleoli in a background rich in small lymphocytes (panels B-C; hematoxylin-eosin stain, objective magnification ×100) with areas of fibrosis. The neoplastic cells were negative to weakly positive for CD30 (panel D; immunohistochemical stain [IHC], objective magnification ×100), weakly positive positive for PAX-5 (panel E; IHC, objective magnification ×100), and positive for CD15 (panel F; IHC, objective magnification ×100). They were negative for CD20 and CD45. More sensitive immunofluorescence testing using tyramide signal amplification (TSA) confirmed low-level expression of CD30 in tumor cells (panels G-H; objective magnification ×40).](https://ash.silverchair-cdn.com/ash/content_public/journal/blood/139/6/10.1182_blood.2021013881/3/m_bloodbld2021013881f1.png?Expires=1769526293&Signature=ZVzMnwhoNh1J-rCLdakSRYsmED3c~HQPt62f42~TeF6WHO3Cotvq50R4FScBnWHS8RvDEGI8iXu-k2R-yUS60g672pn0fpxl8x6pTo6hYho24jsiUpweF4~vr082Hnz4YstZEQqeamsgNGKzSEeB3rGmKLPjoeexpn~HBTEADZ8YSnChEW7--bt7-P04wlwMc1wn9seecAN4J3nrZicGjHbX8on2~kD9Iv~uMu1Sk9MXC3qGx9M5LI4rRMZOo-09a9W-LgNO77jppYdE6eYUyAIXqti-oaUcjd1wHEwJJzmwdofKBHFRXMUbSZqgTlJUCnKN6LNDJgT8MEM1qbb8vg__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA)
