Lymphoma & related disorders
Hodgkin lymphoma
Nodular sclerosis

Topic Completed: 1 August 2011

Minor changes: 5 July 2020

Copyright: 2002-2020,, Inc.

PubMed Search: Nodular sclerosis classic Hodgkin lymphoma

Dragos C. Luca, M.D.
Page views in 2019: 8,014
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Cite this page: Luca D. Nodular sclerosis. website. Accessed August 6th, 2020.
Definition / general
  • 70% of classic Hodgkin lymphoma in Europe and USA
  • More common in rich countries, highest risk in those with high socioeconomic status
  • Similar incidence in males and females (the only classic Hodgkin lymphoma subtype without male predominance)
  • Peaks at 15 - 34 years of age
  • Cervical lymph nodes, mediastinum (80%), bulky disease (54%), spleen or lung (8 - 10), bone (5%), bone marrow (3%), liver (2%)
Clinical features
  • Most present with stage II disease (2/3 have stage I or II disease)
  • B symptoms: 40%
Case reports
  • Better overall prognosis than other types of classic Hodgkin lymphoma
  • > 90% survival at 5 years for early stage disease
  • Adverse prognostic indicator: massive mediastinal disease
Microscopic (histologic) description
  • Nodular growth pattern with broad fibroblast poor birefringent collagen bands surrounding at least one nodule
  • Usually confined within thickened lymphonodular capsule
  • Highly variable numbers of HRS cells, small lymphocytes and other inflammatory cells; often numerous eosinophils, histiocytes and neutrophils; occasional foamy macrophages
  • Mitoses uncommon
  • HRS cells have more lobated nuclei, smaller lobes, less prominent nucleoli, more cytoplasm than other types of classic Hodgkin lymphoma
  • Lacunar cells: formalin fixation artifact of delicate folded or multilobate nuclei surrounded by abundant pale cytoplasm often disrupted or retracted during cutting of sections with formalin fixation (but not B5 or Zenkers), leaving a lacune (empty hole); associated with necrosis and histiocytes (necrotizing granuloma-like)
  • Syncytial variant: prominent aggregates of lacunar cells
  • Grading by number of HRS cells (British National Lymphoma Investigation: 1 - scattered, 2 - aggregates in > 25% of nodules) and number of eosinophils (German HL Study Group: > 5%) is for research protocols but not for routine clinical purposes
Microscopic (histologic) images

Images hosted on other servers:

Lacunar cells

Bands of collagen

Reed-Sternberg cells with bilobed mirror image nuclei, prominent nucleoli and abundant amphophilic cytoplasm

Syncytial variant: figure 1: mediastinal / lung mass;
2: atypical cells with amphophilic cytoplasm, multilobated nuclei with irregular outlines and prominent nucleoli;
4: S100 negative

Positive stains
Negative stains
Differential diagnosis
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