Diagnostic Issues in a Case of Hodgkin Lymphoma with Castleman Like Features

Castleman disease (CD) is a benign heterogenous lymphoproliferative disorder presenting with varied clinical manifestations. Histomorphologically, two distinct variants are known, hyaline vascular type and plasma cell type. CD is reported to be associated with lymphomas. Though Non Hodgkin lymphoma is more commonly associated with CD, its association with Hodgkin lymphoma (HL) is also well known and documented. Many a times, CD obscures or masks the underlying lymphomas thus delaying the diagnosis. There are also reports of HL showing Castleman like features. We report a case of HL with Castleman like features which posed diagnostic difficulty owing to the fragmented nature and tiny size of the initial lymph node biopsy. Striking peripheral blood rouleaux formation which was seen in our case along with bone marrow plasmacytosis has not been described in the previously diagnosed cases.