A lymph node biopsy from a 28-year-old with mediastinal mass shows large cells with bilobed nuclei, prominent eosinophilic 'owl-eye' nucleoli, and a background of lymphocytes, eosinophils, and plasma cells. CD15 and CD30 are positive; CD45 is negative. Which subtype of Hodgkin lymphoma is most likely?

• A Lymphocyte-rich classical Hodgkin lymphoma
• B Mixed cellularity classical Hodgkin lymphoma
• C Nodular lymphocyte-predominant Hodgkin lymphoma
• D Nodular sclerosis classical Hodgkin lymphoma ✓

Explanation

Nodular sclerosis is the most common subtype of classical Hodgkin lymphoma, characteristically presenting in young adults with a mediastinal mass. It features RS cells (lacunar variants) in collagen bands, with CD15+/CD30+/CD45- immunophenotype. Mixed cellularity has prominent eosinophils but lacks collagen bands; lymphocyte-rich has fewer eosinophils; nodular lymphocyte-predominant features 'popcorn' cells that are CD20+/CD15-/CD30-.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.