A 28-year-old man from sub-Saharan Africa presents with painless cervical lymphadenopathy for 4 months, fever, drenching night sweats, and a 10% weight loss. CT scan shows mediastinal and retroperitoneal lymph node enlargement. Lymph node biopsy shows a background of lymphocytes, plasma cells, and eosinophils with scattered large binucleated cells having prominent 'owl eye' nucleoli that are CD30+ and CD15+. Which subtype of Hodgkin's lymphoma is MOST likely?
- A Mixed cellularity classical Hodgkin lymphoma (MC-cHL) ✓
- B Nodular sclerosis classical Hodgkin lymphoma (NS-cHL)
- C Lymphocyte-predominant Hodgkin lymphoma (LPHL)
- D Diffuse large B-cell lymphoma (DLBCL)
Explanation
Mixed cellularity cHL is the subtype most strongly associated with EBV infection and is more common in developing countries (including sub-Saharan Africa), in older patients, and in HIV-infected individuals. It is characterized histologically by a polymorphous background of lymphocytes, plasma cells, eosinophils, and histiocytes with numerous Reed-Sternberg cells (large binucleated cells with prominent 'owl-eye' nucleoli, CD30+/CD15+). NS-cHL is the most common subtype in developed countries, predominantly affects young women, and shows collagen bands creating nodules. LPHL (nodular lymphocyte predominant HL) shows 'popcorn' (L&H) cells that are CD20+/CD30- and has an indolent course. DLBCL is a non-Hodgkin lymphoma without Reed-Sternberg 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.