Track

Abstract

Cutaneous Hodgkin lymphoma (HL) is a rare manifestation of classical Hodgkin lymphoma (cHL), accounting for approximately 0.5%–3.4% of HL cases and usually reflects advanced systemic or relapsed disease. Primary cutaneous presentations, defined by exclusive skin involvement for at least three months without nodal disease, remain controversial and exceptionally rare. We present the case of a 58-year-old woman who presented with a skin mass on the right hip, a non-healing wound on the left ankle and multiple suspicious skin lesions, without systemic symptoms. A dermal shave biopsy of the left ankle revealed a dense dermal infiltrate with scattered large, atypical cells exhibiting Reed-Sternberg-like morphology. Immunohistochemistry demonstrated positivity for CD30, OCT-2, PAX-5, dim/variable CD20, CD15, and EBV-encoded RNA, consistent with cHL. Furthermore, T-cell markers, CD45, BOB-1, and ALK were negative. The key differential included an EBV-positive polymorphic lymphoproliferative disorder. Comprehensive staging was recommended for systemic HL which revealed FDG avid lymph nodes in the groin and left internal iliac areas on whole-body PET imaging. The patient was subsequently diagnosed with stage IV EBV-positive Hodgkin Lymphoma. This case underscores the diagnostic challenges of cutaneous cHL due to its rarity and morphologic and immunophenotypic overlap with other lymphoproliferative disorders, the necessity for thorough clinical and pathological integration, and the critical importance of multidisciplinary evaluation. Recognition of these rare cutaneous presentations is essential given differing prognoses and management approaches.