A 31-year-old man has an isolated enlarged cervical lymph node. Biopsy shows scattered large cells with multilobated, folded nuclei resembling popcorn kernels, surrounded by rosettes of small T lymphocytes. Immunophenotyping of the large cells: CD45+, CD20+, BCL6+, CD15 negative, CD30 negative. Which is the correct diagnosis?

• A Nodular sclerosis classical Hodgkin lymphoma
• B Lymphocyte-rich classical Hodgkin lymphoma
• C T-cell/histiocyte-rich large B-cell lymphoma
• D Nodular lymphocyte-predominant Hodgkin lymphoma ✓

Explanation

Popcorn cells (lymphocyte-predominant cells) that are CD20 and BCL6 positive but CD15 and CD30 negative define nodular lymphocyte-predominant Hodgkin lymphoma, a distinct entity from classical Hodgkin lymphoma. Classical Hodgkin variants, including lymphocyte-rich type, have Reed-Sternberg cells that are CD15 and CD30 positive and usually CD20 weak or negative. This immunophenotypic split explains why NLPHL behaves clinically like an indolent D-cell process rather than classical Hodgkin disease.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.