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Lymphoma - Non B cell neoplasms

Hodgkin lymphoma

Mixed cellularity classical Hodgkin lymphoma

Reviewer: Dragos Luca, M.D. (see Reviewers page)
Revised: 23 September 2012, last major update August 2011
Copyright: (c) 2001-2012, PathologyOutlines.com, Inc.

Definition
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● Subtype of classic Hodgkin lymphoma with scattered Hodgkin Reed-Sternberg (HRS) cells in a diffuse or vaguely nodular mixed inflammatory background without nodular sclerosing fibrosis (WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues, 4th Edition, Lyon 2008)

Terminology
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● Includes cases that do not fit in any other category

Epidemiology
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● 20-25% of all cases of classic Hodgkin lymphoma in developed countries
● More frequent in HIV patients and in developing countries (most common subtype)
● No bimodal age distribution (median age: 38 years)
● Male predominance (~70% of patients)

Sites
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● Cervical and supraclavicular lymph nodes, peripheral lymph nodes (frequently), spleen (30%), bone marrow (10%), liver (3%), other organs (1-3%), mediastinum (uncommon)

Clinical features
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● B symptoms are frequent
● 50% present as stage III or IV with abdominal lymphonodular or splenic involvement

Treatment and prognosis
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● Worse prognosis than nodular sclerosis classic Hodgkin lymphoma but better than lymphocyte depleted classic Hodgkin lymphoma (before modern therapy, almost the same with current regimens)
● Recent studies suggest the number of background histiocytes may be prognostically significant

Case reports
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● Primary gastroesophageal-ileal disease in an immunocompetent patient (Arch Pathol Lab Med 2002;126:1534)

Micro description
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● Effaced lymph node architecture; interfollicular pattern also possible
● May have interstitial fibrosis but no broad bands of sclerosis or capsular thickening
● Typical Hodgkin Reed-Sternberg cells in a variable inflammatory background (eosinophils, histiocytes, neutrophils, plasma cells)
● May have prominent epithelioid histiocytes that may form granulomas (especially in EBV+ cases)

Micro images
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Various images


Stomach/ileal tumor

Positive stains
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● Classic Hodgkin lymphoma phenotype, EBV+ in 75%

Virtual slides
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Lymph node

Differential diagnosis
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● Diffuse large B-cell lymphoma, T-cell lymphoma (Lennert lymphoma), anaplastic large cell lymphoma, infectious mononucleosis or other viral adenitis, angioimmunoblastic T-cell lymphoma

End of Lymphoma - Non B cell neoplasms > Hodgkin lymphoma > Mixed cellularity classical Hodgkin lymphoma

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