A 28-year-old man presents with fever, fatigue, lymphadenopathy, and mediastinal widening on CXR. Biopsy shows Reed-Sternberg cells in a lymphocyte-rich background with scattered plasma cells and eosinophils. Immunophenotype: CD15+, CD30+, CD20–. What is the most likely diagnosis?

• A Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL)
• B Diffuse large B-cell lymphoma (DLBCL)
• C Peripheral T-cell lymphoma
• D Mixed cellularity classical Hodgkin lymphoma ✓

Explanation

Mixed cellularity classical Hodgkin lymphoma shows RS cells with a mixed inflammatory background (plasma cells, eosinophils, lymphocytes, neutrophils). All classical HL subtypes show CD15+/CD30+ RS cells and are CD20 negative. NLPHL has a different immunophenotype: CD20+, CD15–, CD30– with LP ('popcorn') cells. DLBCL and PTCL do not show RS cells.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.