Lymphoma and plasma cell neoplasms
Hodgkin lymphoma
Mixed cellularity classical Hodgkin lymphoma

Author: Dragos Luca, M.D. (see Authors page)

Revised: 25 July 2018, last major update August 2011

Copyright: (c) 2002-2018,, Inc.

PubMed Search: "Mixed cellularity" classical Hodgkin lymphoma

Cite this page: Luca, D. Mixed cellularity classical Hodgkin lymphoma. website. Accessed October 18th, 2018.
Definition / general
  • 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)
  • Includes cases that do not fit in any other category
  • 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)
  • Cervical and supraclavicular lymph nodes, peripheral lymph nodes (frequently), spleen (30%), bone marrow (10%), liver (3%), other organs (1 - 3%), mediastinum (uncommon)
Clinical features
  • B symptoms are frequent
  • 50% present as stage III or IV with abdominal lymphonodular or splenic involvement
  • 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
Microscopic (histologic) description
  • 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)
Microscopic (histologic) images

Images hosted on PathOut server, COW #447 - Hodgkin lymphoma, mixed cellularity subtype, contributed by Dr. Mariam A. Molani:

Mediastinal LN, effaced

Mediastinal LN, atypical cells among mixed inflammatory infiltrate

Reed-Sternberg cells in mediastinal lymph node

Other images hosted on PathOut server:

Various images

Images hosted on other servers:

Various images

Stomach / ileal tumor

Positive stains
  • Classic Hodgkin lymphoma phenotype, EBV+ in 75%
Differential diagnosis