A 45 years old female patient presented painless supraclavicular lymph adenopathy. Biopsy revealed hinucleated acidophilic owl eye appearance with floating lymphocytes in empty space, which was CD 15, CD 30 positive. What is the most probable diagnosis?
Correct Answer: Nodular sclerosis Hodgkin lymphoma
Description: Ans. b. Nodular sclerosis Hodgkin lymphoma (Re} Robbins 9/e p588. 8/e p618-619)In a 45 years old female patient, who presented with painless supraclavicular lymph node enlargement. Biopsy revealed binucleated acidophilic owl eye appearance with floating lymphocytes in erupt}- space, which was CD 15, CD 30 positive. The most probable diagnosis is Hodgkin's lymphoma. Nodular sclerosis, mixed cellularity and lymphocyte-depleted variants are positive for CD 15 and CD30. But Nodular sclerosis variant is most common type and more common in females. So, in the above-mentioned clinical situation, most probable diagnosis is nodular sclerosis variant of Hodgkin 's lymphoma Reed--Sternberg cells are large and are either multinucleated or have a bilobed nucleus (thus resembling an 'owl's eve' appearance) with prominent eosinophilic inclusion-like nucleoli. Reed-Stern berg cells are CD30 and CD 15 positive, usually negative for CD20 and CD45. The presence of these cells is necessary in the diagnosis of Hodgkin's lymphoma - the absence of Reed-Sternberg cells has very high negative predictive value.Nodular sclerosis:Nodular sclerosis is MC ty pe all over the worldQNodular sclerosis is MC in femalesIt has propensity to involve the cervical, supraclavicular and mediastinal lymph nodes of adults and adolescentsLacunar cells of Reed Sternberg cells variant is seenPositive for CD15 and CD30Hodgkin's lymphomaClassified into four types according to Rye's classification:Nodular sclerosis (30-60%)QMixed celluiarity (20-40%)Lymphocyte predominance (<I0%)Lymphocyte dep leted (< 10%)Prognosis: Lymphocytic predominantQ > Nodular sclerosis > Mixed celluiarity > Lymphocyte depletionNodular sclerosis is MC type all over the worldQ whereas mixed celluiarity is MC in IndiaQNodular sclerosis is MC in females and mediastinal involvementQ is particularly commonSubtypesReed Sternberg cells variant* Nodular sclerosis* Mixed celluiarity* Lymphocyte predominance* Lymphocyte depleted* Lacunar cellsQ* Classic Reed Sternberg cellsQ* Popcorn cellQ* Reticular variantQ (more cellular) Subtypes of Hodgkin Lymphoma:SubtypeMorphology and ImmunophenotypeTypical Clinical FeaturesNodular sclerosisFrequent lacunar cells and occasional diagnostic RS cells; background infiltrate composed of T lymphocytes, eosinophils, macrophages, and plasma cells; fibrous bands dividing cellular areas into nodules. RS cells CD15+ CD30+; usually EBV-Most common subtype; usually stage I or II disease; frequent mediastinal involvement: More common in females, most patients young adultsMixed celiularityFrequent mononuclear and diagnostic RScells; background infiltrate rich in T lymphocytes, eosinophils, macrophages, plasma cells; RS cells CD15+, CD30+; 70% EBV+More than 50% present as stage III or IV disease; M greater than F; biphasic incidence, peaking in young adults and again in adults older than 55Lymphocyte richFrequent mononuclear and diagnostic RS cells;background infiltrate rich in T lymphocytes; RS cells CD15+, CD30+; 40% EBV+Uncommon; M greater than F; tends to be seen in older adultsLymphocyte depletionReticular variant: Frequent diagnostic RS cellsand variants and a paucity of background reactive cells; RS cells CD15+, CD30+; most EBV+Uncommon; more common in older males, HIV-infected individuals, and in developing countries; often presents with advanced diseaseLymphocyte predominanceFrequent L and H (popcorn cell) variants in a background of follicular dendritic cells and reactive B cells; RS cells CD20+, CD15-, C30-; EBV-Uncommon; young males with cervical or axillary lymphadenopathy; mediastinal
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