Case 3 - Discussion


 

CD20, 10

CD20, 20

 

CD3, 4

 

CD30, 20

CD30, 20

EBV, 40

EBV, 60

   
   
   
 

LYMPH NODE, RIGHT POSTERIOR NECK, EXCISIONAL BIOPSY:
Interfollicular Hodgkin Lymphoma

Immunohistochemical stains reveal that the large cells are positive for CD30 and LMP1 (EBV). Rare CD15 positive large cells with perinuclear stain are noted. Those large cells are negative for CD20, CD79A, CD45 and CD3.

Interfollicular Hodgkin Lymphoma

MICROSCOPIC FINDINGS

  • Typical appearance of follicular hyperplasia and paucity of interfollicular diagnostic features of seen in classical Hodgkin's disease;

  • Reactive follicles with prominent germinal centers predominate. The germinal centers are composed of mixtures of follicular center cell types and tingible body macrophages. They include mitotic figures, and they are surrounded by typical mantle zone Iymphocytes. In some cases, the follicles exhibit regressive transformation;

  • Areas of Hodgkin's disease lie between the follicles and are almost always more subtle than the follicles. They contain varying proportions of small Iymphocytes, macrophages, eosinophils, plasma cells, Reed-Sternberg cells, and Hodgkin's cells.

DIFFERENTIAL DIAGNOSES

Feature Interfollicular Hodgkin's Disease Immunoblastic Reaction
Follicles Prominent Varies
Paracortex Expanded - subtle Expanded - prominent
Sinuses Histiocytes -inconspicuous Immunoblasts, plasma cells, proteinaceous material
Interfollicular cells Dimorphism - small Iymphocytes, Hodgkin's cells Cell spectrum: small Iymphocytes, immunoblasts, plasma cells
Necrosis Absent Present
  • Kikuchi's histiocytic necrotizing lymphadenitis: lack of diagnostic Reed-Sternberg cells, and the immunoblasts, while sometimes expressing CD30, are negative for CD15.

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

  • 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 Iymphocytes in the immediate vicinity of the Hodgkin's cells are predominantly T-cell phenotype.

  • 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