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Presented by Ashley Cimino-Mathews, M.D. and prepared by Nathan Cuka, M.D.
Case 2: A 30 year-old female is found to have mediastinal and lung masses, and the upper lobe is resected.
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Week 571: Case 2
A 30 year-old female is found to have mediastinal and lung masses, and the upper lobe is resected.images/ncuka/20131125/2a.jpg
images/ncuka/20131125/2b.jpg
images/ncuka/20131125/2c.jpgCorrect
Answer: Classical Hodgkin lymphoma
Histology: This section of lung shows essentially no normal underlying alveolated lung parenchyma, with focal areas of respiratory epithelium of the underlying bronchioles. The tissue is replaced by dense bands of fibrosis surrounding nodules of inflammatory cells comprised of small lymphocytes, histiocytes, plasma cells and neutrophils. Within these nodules of chronic inflammatory cells are scattered atypical cells with occasional bi- and tri-nucleation and prominent nucleoli. These large atypical cells are positive for CD30, CD15, weakly positive for CD20, and negative for EBV.
CD30:
CD15:
Discussion: Hodgkin lymphomas are separated into the classical Hodgkin lymphomas (nodular sclerosis, mixed cellularity, lymphocyte rich, and lymphocyte depleted subtypes) and the nodular lymphocyte predominant Hodgkin lymphomas (NLPHL). Classical Hodgkin lymphomas are characterized by the presence of Reed-Sternberg and variant Hodgkin cells admixed with abundant background T cells and mixed inflammatory cells. The majority of cells in the lesion, in fact, are the non-neoplastic cells. These Reed Sternberg cells are typically positive for CD15 and CD30, and negative for CD45, and about half of these are positive for EBV by in situ hybridization. About 20% of cases are positive for CD20, and this should be noted in the pathology report. The various subtypes of Classical Hodgkin lymphomas are subdivided based upon the presence of nodularity and sclerosis as well as the density and type of background lymphocytes.
In contrast, the NLPHL contain neoplastic cells called “lymphocyte predominant” (LP) cells, which are also called “popcorn” cells due to the convoluted contour of the nuclei, admixed with T cells that rosette around the LP cells as well as background B cells. LP cells are positive for CD45 and negative for CD15, CD30, and EBV.
This patient also had evidence of Hodgkin lymphoma in her mediastinal lymph nodes and thymus. It is uncommon to see the lung as the solitary site of primary Hodgkin lymphoma.
Reference(s):
– Harris NL. Shades of gray between large B-cell lymphomas and Hodgkin lymphomas: differential diagnosis and biological implications. Mod Pathol. 2013 Jan;26 Suppl 1:S57-70.
– Küppers R. The biology of Hodgkin’s lymphoma. Nat Rev Cancer. 2009 Jan;9(1):15-27.Incorrect
Answer: Classical Hodgkin lymphoma
Histology: This section of lung shows essentially no normal underlying alveolated lung parenchyma, with focal areas of respiratory epithelium of the underlying bronchioles. The tissue is replaced by dense bands of fibrosis surrounding nodules of inflammatory cells comprised of small lymphocytes, histiocytes, plasma cells and neutrophils. Within these nodules of chronic inflammatory cells are scattered atypical cells with occasional bi- and tri-nucleation and prominent nucleoli. These large atypical cells are positive for CD30, CD15, weakly positive for CD20, and negative for EBV.
CD30:
CD15:
Discussion: Hodgkin lymphomas are separated into the classical Hodgkin lymphomas (nodular sclerosis, mixed cellularity, lymphocyte rich, and lymphocyte depleted subtypes) and the nodular lymphocyte predominant Hodgkin lymphomas (NLPHL). Classical Hodgkin lymphomas are characterized by the presence of Reed-Sternberg and variant Hodgkin cells admixed with abundant background T cells and mixed inflammatory cells. The majority of cells in the lesion, in fact, are the non-neoplastic cells. These Reed Sternberg cells are typically positive for CD15 and CD30, and negative for CD45, and about half of these are positive for EBV by in situ hybridization. About 20% of cases are positive for CD20, and this should be noted in the pathology report. The various subtypes of Classical Hodgkin lymphomas are subdivided based upon the presence of nodularity and sclerosis as well as the density and type of background lymphocytes.
In contrast, the NLPHL contain neoplastic cells called “lymphocyte predominant” (LP) cells, which are also called “popcorn” cells due to the convoluted contour of the nuclei, admixed with T cells that rosette around the LP cells as well as background B cells. LP cells are positive for CD45 and negative for CD15, CD30, and EBV.
This patient also had evidence of Hodgkin lymphoma in her mediastinal lymph nodes and thymus. It is uncommon to see the lung as the solitary site of primary Hodgkin lymphoma.
Reference(s):
– Harris NL. Shades of gray between large B-cell lymphomas and Hodgkin lymphomas: differential diagnosis and biological implications. Mod Pathol. 2013 Jan;26 Suppl 1:S57-70.
– Küppers R. The biology of Hodgkin’s lymphoma. Nat Rev Cancer. 2009 Jan;9(1):15-27.
