Histology of a lymph node biopsy shows a bimodal pattern with scattered large lacunar cells (RS variants) in a background of nodular sclerosis with collagen bands and mixed cellularity. CD15+, CD30+, CD45−. What distinguishes this Hodgkin lymphoma subtype histologically?
- A Predominance of eosinophils and plasma cells without sclerosis
- B Diffuse effacement with numerous lymphocytes and rare RS cells
- C Broad collagen bands dividing lymph node into nodules with lacunar RS cell variants ✓
- D L&H (popcorn) cells in a background of small lymphocytes
Correct answer: C. Broad collagen bands dividing lymph node into nodules with lacunar RS cell variants
Explanation
The nodular sclerosis subtype of classical Hodgkin lymphoma is defined histologically by broad birefringent collagen bands (sclerosis) dividing the lymphoid tissue into cellular nodules, with characteristic lacunar cell variants of Reed-Sternberg cells (cells with retraction artefacts in formalin-fixed tissue). It is the most common subtype in developed countries, particularly in young women with mediastinal disease. L&H (lymphocyte-predominant/popcorn) cells characterize nodular lymphocyte-predominant Hodgkin lymphoma, which is CD15−/CD30−/CD45+/CD20+.
Reference: Robbins & Cotran Pathologic Basis of Disease, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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