A 30-year-old man presents with painless cervical lymphadenopathy and mediastinal widening. Biopsy shows large lacunar cells with multilobated nuclei in a background of eosinophils, plasma cells, and fibrosis dividing the lymph node into nodules. Which subtype of Hodgkin lymphoma does this represent?

• A Mixed cellularity — most common in HIV-positive patients
• B Lymphocyte-rich — highest Reed-Sternberg to background ratio
• C Lymphocyte-depleted — most aggressive classical subtype
• D Nodular sclerosis — best prognosis among classical subtypes when localized ✓

Explanation

Nodular sclerosis Hodgkin lymphoma is characterized by collagen bands creating nodules, lacunar cells (a variant of Reed-Sternberg cells), and a polymorphous background with eosinophils. It is the most common subtype in young adults, preferentially involves mediastinal nodes, and has a favorable prognosis when localized. Mixed cellularity is more common in HIV patients, while lymphocyte-depleted is the rarest and most aggressive subtype.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.