Primary Cutaneous Hodgkin Lymphoma: A Rare Disease Variant and Review of the Literature

A 49-year-old man presented with a 2-year history of an enlarging ulcerated plaque over the right forearm with an associated history of pruritus. Skin biopsy demonstrated an infiltrate of lymphocytes in the dermis and subcutis, together with atypical cells with large nuclei and prominent nucleoli resembling Reed-Sternberg cells. Immunohistochemical staining showed that the cells were positive for CD30 and CD15, but negative for LCA, CD20, CD3 & ALK1, consistent with classic Hodgkin Lymphoma. Computerized tomography, bone marrow biopsy and blood work-up revealed no systemic features, confirming a diagnosis of Primary Cutaneous Hodgkin lymphoma (PCHL). The patient received four cycles of ABVD (adriamycin, bleomycin, vinblastine and dacarbazine) with regression of the tumor but subsequently died due to pulmonary tuberculosis and pulmonary thromboembolism.