Hodgkin Lymphoma in Pediatric Patients with Unusual Cytologic Findings

Background: Background: Cytologic findings of classic Hodgkin lymphoma are highly characteristic; very large Reed–Sternberg cells or their mononuclear variants, the Hodgkin cells (HRS cells), stand out against a reactive background. Aims and Objectives: To study the cytological features of Hodgkin lymphoma in paediatric patients, with special emphasis on unusual cytologic findings. Materials and Methods: Seven paediatric lymph node cases of Hodgkin lymphoma, in the age range of 0–12 years, were included in this retrospective study. Outcomes were compared with results of subsequent histopathology. Results: Seven cases were diagnosed as Hodgkin lymphoma on fine needle aspiration cytology (FNAC), with ages ranging from 4 to 7 years. All were male patients. Eosinophilia in peripheral blood smear was present in two out of seven cases (28.57%). Eosinophils in FNAC smears were seen in six out of seven cases (85.71%). The neoplastic cells were mononuclear, binucleate (classic Reed–Sternberg), multinucleated, multilobated, and Popcorn cells. Unusual characteristics observed among RS cells of Hodgkin lymphoma included: Presence of germinal centre cells, Presence of bare/naked nuclei, Emperipolesis, Crushing artefact causing differential diagnosis of anaplastic large cell lymphoma (ALCL) Conclusion: Although Hodgkin lymphoma exhibits characteristic cytologic findings, unusual features may also be present, as highlighted in this study. When these atypical findings are the only ones observed in cytology smears, a careful search for RS cells is essential to avoid misdiagnosis.