Hodgkin's Lymphoma MCQs

This is classical description of NLPHL. (Nodular lymphocyte predominant Hodgkin lymphoma) Reference: Robbins & Cotran Pathologic Basics of Diseases 9 th Edition page No.606

HL can be classified into two clinicopathological entities: the nodular lymphocyte predominant type (NLPHL) which represents 5% of cases and are virtually never associated with EBV, and the classical HL, which can be further subdivided in four morphological subtypes: nodular sclerosis (NSHL) which accounts for the majority of cases, mixed cellularity (MCHL), lymphocyte-rich (LRHL) and lymphocyte-depleted (LDHL). Reference: Massini, G., Siemer, D., & Hohaus, S. (2009). EBV in Hodgkin Lymphoma. Mediterranean journal of hematology and infectious diseases, 1(2), e2009013. https://doi.org/10.4084/MJHID.2009.013

Lymphohistiocytic variants (L and H cells) with polypoid nuclei, inconspicuous nucleoli, and moderately abundant cytoplasm are characteristic of the lymphocyte predominance subtype Hodgkin lymphoma. Reference: Robbins 9th ed p 608

Ans. C: Nodular Sclerosis Type Reed-Sternberg cells (also known as lacunar histiocytes for certain types) are different giant cells found on light microscopy in biopsies from individuals with Hodgkin's lymphoma (aka Hodgkin's disease; a type of lymphoma), and certain other disorders. They are usually derived from B lymphocytes.

PAX-5 is a B-cell differentiation including lymphoblasts (used as a novel pan B-cell marker); also seen in R-S cells in NLPHL (+) vs. classic HL (weak). Reference: Robbins & Cotran Pathologic Basis of Diseases 10 th edition, chapter 13, pg 594

NLPHL is now considered to be a distinct entity from HL. The neoplastic cells in NLPHL are called the HRS like cells or L&H cells or popcorn cells. They lack CD15 and CD 30 unlike RS cells. They are positive for CD19, 20, 45, 79a and BCL2. They run a chronic indolent course. EBV is implicated in HL and not NLPHL.