A lymph node biopsy from a 35-year-old shows Reed-Sternberg cells in a background of lymphocytes, plasma cells, eosinophils, and fibrosis in a nodular pattern. Immunohistochemistry: RS cells are CD15+, CD30+, CD45-, PAX5 weakly positive. Which subtype of classical Hodgkin lymphoma is this, and what is the relevant EBV association?

• A Nodular sclerosis; lowest EBV association (~20%)
• B Lymphocyte-rich classical HL; intermediate EBV association (~40%)
• C Lymphocyte-depleted; moderate EBV association (~50%)
• D Mixed cellularity; highest EBV association (~75%) ✓

Explanation

The histology described — RS cells in a mixed inflammatory background of lymphocytes, plasma cells, and eosinophils without prominent sclerosis — is classic for mixed cellularity Hodgkin lymphoma (MCHL). MCHL has the highest EBV association (~75% of cases), particularly LMP1-positive RS cells, compared to nodular sclerosis (~20–40%). CD15+/CD30+ with dim PAX5 is the characteristic immunophenotype of classical HL RS cells. Lymphocyte-depleted subtype has intermediate-high EBV positivity (~75%) but is rare.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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