A 58-year-old with a mediastinal mass on biopsy shows large cells with lacunar-type retraction artifact, CD15+, CD30+, CD20−, PAX5 dim+, CD45−, EBV EBER in situ hybridization negative. According to WHO 2022 classification, this is best classified as:
- A Classical Hodgkin lymphoma, nodular sclerosis subtype ✓
- B Classical Hodgkin lymphoma, mixed cellularity subtype
- C Primary mediastinal large B-cell lymphoma
- D Nodular lymphocyte predominant Hodgkin lymphoma
Correct answer: A. Classical Hodgkin lymphoma, nodular sclerosis subtype
Explanation
Nodular sclerosis classical Hodgkin lymphoma (cHL-NS) is the most common subtype in the mediastinum in young adults; it is characterized by broad fibrous bands creating nodules and lacunar cells (retraction artifact). The immunophenotype CD30+, CD15+, PAX5 dim+, CD45−, CD20− is typical of all cHL subtypes; EBV is negative in NS but positive in mixed cellularity. NLPHL shows LP cells ('popcorn cells') that are CD20+, CD45+, CD30−, CD15−, and EBV negative, distinguishing it from cHL.
Reference: Robbins & Cotran Pathologic Basis of Disease, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.