Subtype Morphology and Immunophenotype Typical Clinical Features

Nodular sclerosis Frequent lacunar cells and occasional diagnostic R-S cells;

background infiltrate composed of T lymphocytes, eosinophils,

macrophages and plasma cells; fibrous bands dividing cellular

areas into nodules. R-S cells CD15+, CD30+; EBV-.

Stage 1 or 2 disease most common.

Frequent mediastinal involvement.

F = M, most patients young adults

Mixed cellularity Frequent mononuclear and diagnostic R-S cells; background

infiltrate rich in T lymphocytes, eosinophils, macrophages,

plasma cells. R-S cells CD15+, CD30+; 70% EBV+.

More than 50% present as stage 3 or 4 disease. M > F. Biphasic incidence,

peaking in young adults and again in adults older than 55.

Lymphocyte-rich Frequent mononuclear and diagnostic R-S cells; background

infiltrate rich in T lymphocytes. R-S cells CD15+, CD30+; 40%

EBV+.

Uncommon. M > F. Tends to be seen in older adults.

Lymphocyte depletion Reticular variant: Frequent diagnostic R-S cells and variants

with a paucity of background reactive cells; diffuse fibrosis

variant; hypocellular fibrillar background with scattered

diagnostic R-S cells and variants and few reactive cells. R-S

cells CD15+, CD30+; most EBV+.

Uncommon. More common in older males, HIV-infected individuals, and in

developing countries. More likely to present with advanced disease.

Lymphocyte predominance Frequent L&H (popcorn cell) variants in a background of

follicular dendritic cells and reactive B cells. R-S cells CD20+,

CD15-, C30-; EBV-.

Uncommon. Young males with cervical or axillary lymphadenopathy.

Mediastinal.

and other organs and tissues can appear in due course and take the form of irregular tumor nodules resembling those present in the nodes.

The nodular sclerosis type occurs with equal frequency in males and females. It has a propensity to involve the lower cervical, supraclavicular, and mediastinal lymph nodes of adolescents

or young adults and is only rarely associated with EBV. The prognosis is excellent.

Hodgkin Lymphoma, Mixed Cellularity Type.

This form of HL constitutes about 20% to 25% of cases. Lymph node involvement by the mixed cellularity type takes the form of diffuse effacementby a heterogeneous cellular infiltrate,

which includes small lymphocytes, eosinophils, plasma cells, and benign macrophages admixed with the neoplastic cells ( Fig. 14-25 ). Diagnostic Reed-Sternberg cells and

mononuclear variants are usually plentiful.The immunophenotype is identical to that observed in the nodular sclerosis type. Small lymphocytes in the background are predominantly T

cells, and early nodal disease preferentially involves paracortical T-cell zones.

Mixed cellularity HL is more common in males and strongly associated with EBV, as the Reed-Sternberg cells contain EBV genomes in at least 70% of cases. Compared to the lymphocyte

predominance and nodular sclerosis subtypes, it is more likely to be associated with older age, systemic symptoms such as night sweats and weight loss, and advanced tumor stage.

Nonetheless, the prognosis is very good.

Date: 2016-04-22; view: 844