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

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Table of Contents

Cite this page: Luca DC. Mixed cellularity. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/lymphomanonBmixed.html. Accessed December 3rd, 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)