36 year old, Jemima, is sent for mediastinoscopy with biopsy. During this procedure, a small incision is made immediately above the sternum and a rigid tube is inseed into the chest cavity for visualization of the mediastinum by video camera. Several biopsies of lymph nodes are taken and sent for pathologic examination. In these biopsies, the normal lymphoid tissue has been replaced by a mixed population of morphologically normal cells including histiocytes, lymphocytes, monocytes, plasma cells, and eosinophils. Admixed with these cells are infrequent numbers of large binucleate cells with large prominent eosinophilic nucleoli. Immunophenotyping demonstrates that these cells are positive for CD15 and CD30. The CD15 and CD30 positive cells are most likely which of the following?
36 year old, Jemima, is sent for mediastinoscopy with biopsy. During this procedure, a small incision is made immediately above the sternum and a rigid tube is inseed into the chest cavity for visualization of the mediastinum by video camera. Several biopsies of lymph nodes are taken and sent for pathologic examination. In these biopsies, the normal lymphoid tissue has been replaced by a mixed population of morphologically normal cells including histiocytes, lymphocytes, monocytes, plasma cells, and eosinophils. Admixed with these cells are infrequent numbers of large binucleate cells with large prominent eosinophilic nucleoli. Immunophenotyping demonstrates that these cells are positive for CD15 and CD30. The CD15 and CD30 positive cells are most likely which of the following?
💡 Explanation
## **Core Concept**
The question describes a histopathological finding from a mediastinoscopy and biopsy procedure. The key details include the presence of a mixed population of morphologically normal cells and infrequent large binucleate cells with prominent eosinophilic nucleoli. These large cells are positive for CD15 and CD30, which are specific markers used in immunophenotyping to identify certain types of cells, particularly in the context of lymphomas.
## **Why the Correct Answer is Right**
The large binucleate cells with prominent eosinophilic nucleoli, which are positive for CD15 and CD30, are characteristic of **Reed-Sternberg cells**. These cells are pathognomonic for Hodgkin lymphoma, a type of lymphoma that originates from lymphocytes. The presence of these cells, along with a mixed inflammatory background, is typical for **Classical Hodgkin Lymphoma (cHL)**. The Reed-Sternberg cells in cHL express CD15 and CD30, which are key markers for the diagnosis of this condition.
## **Why Each Wrong Option is Incorrect**
- **Option A:** This option is incorrect because while it's a type of lymphoma, the specific details provided (CD15 and CD30 positivity, presence of Reed-Sternberg cells) point more directly to Hodgkin lymphoma rather than another category of lymphomas like Non-Hodgkin Lymphoma (NHL).
- **Option B:** This option might seem plausible but does not directly correspond with the description given. The details provided fit better with a specific subtype of lymphoma rather than a broad category.
- **Option C:** This option is incorrect because the description provided does not match the typical characteristics of the mentioned condition. The key here is the presence of Reed-Sternberg cells and their immunophenotype.
## **Clinical Pearl / High-Yield Fact**
A crucial point to remember is that **Reed-Sternberg cells** are diagnostic for Hodgkin lymphoma when seen in the appropriate clinical and pathological context. These cells are typically **CD15+** and **CD30+**, which helps differentiate Hodgkin lymphoma from other types of lymphomas. The presence of these cells in a background of mixed inflammation is highly suggestive of classical Hodgkin lymphoma.
## **Correct Answer:** D. Reed-Sternberg cells.
✓ Correct Answer: D. Reed-Sternberg cells
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