A 13-year-old girl presents with a 6-week history of a painless, firm left supraclavicular lymph node and drenching night sweats with documented weight loss of 4 kg. Excision biopsy shows effaced architecture with lacunar variant Reed-Sternberg cells in nodules separated by collagen bands. Which is the most likely subtype and its expected prognosis among classical Hodgkin lymphoma subtypes?

• A Lymphocyte rich, worst prognosis
• B Nodular sclerosis, relatively favorable prognosis ✓
• C Mixed cellularity, worst prognosis
• D Lymphocyte depleted, best prognosis

Explanation

Lacunar variant Reed-Sternberg cells within collagen-banded nodules define the nodular sclerosis subtype, the commonest form of classical Hodgkin lymphoma and the type most typical of adolescents and young adults, often presenting in supraclavicular or mediastinal nodes. Nodular sclerosis carries a relatively favorable outcome compared with mixed cellularity and lymphocyte depletion, the latter having the worst prognosis and the highest proportion of Reed-Sternberg cells. Lymphocyte rich also behaves favorably, ruling out option A.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.