Lymphoma & related disorders
Hodgkin lymphoma
Mixed cellularity
Author: Dragos C. Luca, M.D.
Topic Completed: 1 August 2011
Minor changes: 29 December 2020
Copyright: 2002-2021, PathologyOutlines.com, Inc.
PubMed Search: "Mixed cellularity" classic Hodgkin lymphoma
Table of Contents
Definition / general | Terminology | Epidemiology | Sites | Clinical features | Treatment | Case reports | Microscopic (histologic) description | Microscopic (histologic) images | Positive stains | Differential diagnosisCite this page: Luca DC. Mixed cellularity. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/lymphomanonBmixed.html. Accessed May 6th, 2021.
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)
Terminology
- Includes cases that do not fit in any other category
Epidemiology
- 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
- 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
Treatment
- 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
- Primary gastroesophageal-ileal disease in an immunocompetent patient (Arch Pathol Lab Med 2002;126:1534)
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
Contributed by Mariam A. Molani, M.D. (Case #447)
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
Positive stains
- Classic Hodgkin lymphoma phenotype, EBV+ in 75%
Differential diagnosis
- Diffuse large B cell lymphoma, T cell lymphoma (Lennert lymphoma), anaplastic large cell lymphoma, infectious mononucleosis or other viral adenitis, angioimmunoblastic T cell lymphoma
