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Subtype Morphology and Immunophenotype Typical Clinical FeaturesNodular 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: 1062
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