CLL/SLL with Hodgkin Lymphoma

CLL/SLL may show Reed-Sternberg-like cells in two situations: 1) Prototypic case of CLL/SLL in which scattered Reed-Sternberg cells are found incidentally admixed with the small round lymphocytes. 2) CLL/SLL cases with evidence of overt transformation to Hodgkin lymphoma in which the Reed-Sternberg cells are found in background of polymorphous infiltrate separate from the CLL cells. Such cases are analogous to Richter syndrome. This case represents the latter situation. The patient presented with generalized lymphadenopathy. An enlarged cervical lymph node was excised. The image shows sheets of typical small mature B-lymphocytes of CLL/SLL. Discrete areas of Hodgkin-like transformation with Reed-Sternberg cells were scattered throughout the lymph node (see the next two images).