A 55-year-old man has a mediastinal mass with biopsy showing large cells with lobulated nuclei, abundant clear cytoplasm, positive for CD30, CD15, CD20 (weak), and EBV-LMP1. He is HIV-negative. The WHO 2022 classification best characterizes this as:

• A Primary mediastinal large B-cell lymphoma
• B Classic Hodgkin lymphoma, mixed cellularity subtype
• C Classic Hodgkin lymphoma, lymphocyte-depleted subtype
• D EBV-positive diffuse large B-cell lymphoma, NOS ✓

Explanation

EBV-positive DLBCL, NOS is characterized by large B-cells expressing CD20, CD30 (in some cases), and EBV antigens including LMP1, occurring in immunocompetent adults over age 50. While CD15 can occasionally be positive, the strong CD20 positivity and EBV-LMP1 expression in an immunocompetent patient favors EBV-positive DLBCL over classic Hodgkin lymphoma, where the Reed-Sternberg cells are typically CD20-negative or weakly positive. In the WHO 2022 classification, this entity is recognized as a distinct aggressive B-cell lymphoma with EBV-driven pathogenesis.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.