A 35-year-old woman presents with mediastinal mass, B-symptoms, and peripheral blood lymphocytosis. Biopsy shows large lacunar cells within a fibrous background with a Reed-Sternberg cell variant expressing CD15+, CD30+, CD20+ (weak), and PAX5+ (weak), with negative CD45. The WHO 5th edition (2022) classification most accurately designates this as:
- A Nodular sclerosis classic Hodgkin lymphoma (NSCHL), grade 2 ✓
- B Primary mediastinal large B-cell lymphoma (PMBCL)
- C Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL)
- D Mediastinal gray zone lymphoma (MGZL)
Explanation
Nodular sclerosis classic Hodgkin lymphoma (NSCHL) characteristically presents in young women with anterior mediastinal mass, fibrous bands dividing lymph node into nodules, and lacunar cell variant RS cells. The immunophenotype CD15+, CD30+, CD20 weak/negative, PAX5 weak+, CD45− is diagnostic of CHL. PMBCL expresses CD20 strongly and CD30 variably but lacks CD15 and has a different morphology. NLPHL shows LP cells (popcorn cells) with CD20+, CD45+, CD15−, CD30− profile. MGZL shares features of both CHL and PMBCL with a transitional immunophenotype and is classified separately in WHO 2022.
Reference: Robbins & Cotran Pathologic Basis of Disease, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.