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Concomitant classic Hodgkin lymphoma and schistosomiasis

An 11-year-old boy in Rwanda presented with a 3-month history of weight loss, fevers, and abdominal pain. Physical examination revealed a marasmic male with a large hypogastric mass and bilateral lower extremity edema. Urine and stool analyses were negative for ova and parasites. Ultrasound imaging revealed an 18 cm mesenteric mass compressing the left kidney and diffuse abdominopelvic lymphadenopathy. An excisional biopsy of the mass revealed Schistosoma mansoni larvae dispersed in a fibrous stroma with numerous macrophages, lymphocytes, and eosinophils (Image 1A-1B). Also scattered among the inflammatory cells were large multinucleated cells with prominent macronucleoli (Image 1C) and characteristic positivity for PAX-5 weakly (Image 1D), CD30 (Image 1E), and CD15 (Image 1F), consistent with Hodgkin Reed-Sternberg (HRS) cells. The patient received praziquantel and a chemotherapy regimen consisting of cyclophosphamide, vincristine sulfate, prednisone, and dacarbazine. Concurrent classic Hodgkin lymphoma (CHL) and schistosomiasis are exceedingly rare. Both diseases show prominent reactive background