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Case 178 - Discussion

Hematopathology Case





Classic Hodgkin Lymphoma, Mixed Cellularity Subtype

  • Second most frequent subtype, 20-30% of CHL

  • High percentage of this subtype in children and older patients

  • Frequently in stages III and IV and with B symptoms, more often below or on both sides of the diaphragm

  • EBV+, ~ 75%

  • Histopathology:

    • Lymph node architecture usually diffusely obliterated; early involvement often interfollicular growth pattern or residual or atrophic GCs

    • Frequent tumor cells, evenly dispersed

    • Background: heterogeneous population of small lymphocytes, eosinophils, plasma cells, and histiocytes. Lymphocytes may show mild pleomorphism, but no frank atypia

    • Histiocyte-rich variant: abundant clusters of epithelioid histiocytes

    • May have noncaseating, sarcoid-type granulomas in lymph nodes or other tissues in the vicinity of involved nodes

    • Usually lack of collagen fibrosis, necrosis and clusters of tumor cells