HODGKINS-DISEASE VARIANT OF RICHTERS-SYNDROME - REPORT OF A CASE WITHDIAGNOSIS BY FINE-NEEDLE BIOPSY

BACKGROUND: Chronic lymphocytic leukemia (CLL) with transformation int o large cell lymphoma (Richter's syndrome) is a well-documented phenom enon. Only rarely does CLL terminate in Hodgkin's disease (HD) as Rich ter's syndrome. Reports of Hodgkin's variant of Richter's syndrome pro ven by histologic and immunohistologic evaluation have been published, but no cytologic reports of this entity exist. Distinguishing between large cell lymphoma and HD as variants of Richter's syndrome is essen tial because of recent reports of improved prognosis in HD. CASE: We r eport a case of a 65-year-old male previously diagnosed with CLL who s ubsequently developed fever, fatigue, an intraabdominal mass and enlar ged periaortic lymph nodes. Fine needle biopsy (FNB) and immunophenoty ping by flow cytometry of the mass revealed cytologic and immunophenot ypical cells of CLL admired with binucleate and multinucleate cells wi th prominant eosinophilic nucleoli consistent with Reed-Sternberg cell s. CONCLUSION: This is the first reported case of HD variant of Richte r's syndrome diagnosed by FNB. As FNB becomes more common in the follo w-up of lymphoreticular diseases, cytologists should be aware of this unusual HD variant of Richter's syndrome.