Anaplastic KI-1 (CD30) positive large cell lymphoma of the stomach mimicking Hodgkin's disease: A case report and review of the literature

Primary gastric Hodgkin's lymphoma: A rare coincidence

Mostly primary gastric lymphomas are of the non-Hodgkin variety. Primary Hodgkin lymphoma (HL) of the stomach is an unusual entity that may be a big challenge in diagnosis. We reporter are case presenting as gastric outlet obstruction, which was later diagnosed as primary Hodgkin's Lymphoma of the stomach. Its rare coincidence makes it worth to be reported to sensitize clinicians as well as pathologists for the uncommon extra nodal site of Hodgkin's Lymphoma.

Primary gastric Hodgkin's lymphoma

Background

Primary Hodgkin's disease of the stomach is an extremely rare entity. Nearly all cases of primary gastric lymphoma are of the non-Hodgkin's variety. Diagnoses in such cases are difficult due to considerable histological similarities between the 2 disease entities.

Case presentation

We report the case of a 77 year old lady with a 1 year history of weight loss and poor appetite. Physical examination was unremarkable. Subsequent multiple upper GI endoscopies revealed a large malignant looking ulcer which was deemed to be histologically benign. Following CT imaging the patient underwent a radical gastrectomy. Postoperatively histology and immunohistochemistry failed to confirm a diagnosis. As such a second opinion was sought. Employing an extended array of immunohistological staining a diagnosis of 'Classical Hodgkin's' disease of the stomach was achieved.

Conclusion

Our case illustrates the significant difficulties in achieving a rare diagnosis of primary Hodgkin's lymphoma of the stomach. The non-specific nature of symptoms and a lack of histological features make a preoperative diagnosis extremely difficult. While immunohistochemistry is widely employed in aiding the evaluation of such cases, one should be wary of the considerable overlap in differentiating between Hodgkin's and non-Hodgkin's disease entities using this technique.