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Case  3 - Discussion

Hematopathology Case

 

CD20, 10

CD20, 20

 

CD3, 4

 

CD30, 20

CD30, 20

EBV, 40

EBV, 60

   

Summary of immunostains:  the large tumor cells are positive for CD30 and LMP1 (EBV). Rare CD15 positive large cells with perinuclear stain are noted. They are negative for CD20, CD79A, CD45 and CD3.
Diagnosis: Lymphocyte-rich subtype of classic Hodgkin lymphoma, nodular variant

 

Classic Hodgkin Lymphoma (cHL)

Lymphocyte-Rich Subtype, Nodular Variant

MICROSCOPIC FINDINGS

  • The lymphocyte-rich subtype of cHL has two major growth patterns: a nodular pattern (frequent) and a diffuse one (rare).

  • The nodular variant shows partially preserved lymph node architecture with an easily discernible, occasionally focally developed nodularity. The nodules consist of B cells often with a regressed, eccentrically placed germinal center

  • The neoplastic cells are usually present in the expanded mantle zones in a dispersed pattern, and groups or clusters of tumor cells are infrequent

  • The tumor cells mostly show typically morphologic features of classic RS cells, but may have LP cell morphology as seen in NLPHL

  • The reactive background consists predominantly of small IgM+ and IgD+ B cells, typical for the mantle zone cells

  • Progressively transformed germinal centers (PTGC) are not a feature of LRCHL

  • May have groups of epithelioid cells, which can closely resmeble NLPHL

  • Other inflammatory cells such as eosinophils are usually rare

DIFFERENTIAL DIAGNOSES

  • Immunoblastic reaction: the reactive immunoblasts are usually smaller the HL tumors with round nuclei, smaller and bluish nucleoli and less cytoplasm, CD30 often positive but CD15 usually negative

  • Castleman's disease: characterized by follicular hyperplasia, regressive transformation of germinal centers, marked interfollicular and hilar plasmacytosis, and dilated lymph node sinuses. Lack of diagnostic CD15+ Reed-Sternberg cells

  • Kikuchi's histiocytic necrotizing lymphadenitis: lack of diagnostic Reed-Sternberg cells, and the immunoblasts, while sometimes expressing CD30, are negative for CD15

  • PTGC and NLPHL

  • Follicular and parafollicular (monocytoid B-cell) hyperplasia

IMMUNOHISTOCHEMISTRY AND SPECIAL STAINS

  • The Hodgkin's cells and RS cells exhibit membrane and paranuclear globular staining for both CD15 (Leu-Ml) and CD30 (Ber-H2), and they lack staining for CD45 (leukocyte common antigen) and KiB3

  • The small lymphocytes in the immediate vicinity of the Hodgkin's cells are predominantly CD3+ T-cell phenotype, which rim tumors but lack CD57 and PD1

  • The reactive germinal centers lack staining for BCL2

REFERENCES

  • Doggett R, Colby TV, Dorfman RF: Interfollicular Hodgkin's disease. Am J Surg Pathol 1983;7:145-149.

  • Interfollicular Hodgkin's lymphoma and Castleman's disease. Histopathology. 2006 Feb;48(3):317-9.

  • http://researchpath.hitchcock.org/socforheme/specialty/Spechem965.html

  • Hematopathology, 2011, Jaffe