A 20 years old boy presented with persistent cervical lymphadenopathy for the past 1 year. Histopathology of lymph node shows Reed-Sternberg cells with focal nodularity and background of T reactive lymphocytes. The cells were positive for CD20, LCA, EMA and negative for CD15 and CD30 and EBV negative. Diagnosis is:
(A) Nodular lymphocyte predominant Hodgkin's lymphoma (B) Lymphocyte rich Hodgkin's lymphoma (C) Diffuse large B-cell lymphoma (D) Small cell lymphoma
(A) Answer- A. Nodular lymphocyte predominant Hodgkin's lymphomaThis tumor contains so-called L&H (lymphocytic and histiocytic) variants, which have a multilobed nucleus resembling a popcorn kernel ("popcorn cell"). Eosinophils and plasma cells are usually scant or absent. In contrast to the Reed-Sternberg cells found in classical forms of HL, L&E variants express B-cell markers typical of germinal-cenler B cells, sach as CD20 and BCL6, and are usually negative for CD15 and CD30.Histological diagnosis is established by presence of Reed-Sterntrerg cells along with background of mixed inflammation consisting of neutrophils, plasma cells, eosinophils & histiocytes.Reed-Sternberg cells are large and are either multinucleated or have a bilobed nucleus (thus resembling an "owl's eye" appearance) with prominent eosinophilic inclusion-like nucleoli.Reed-Sternberg cells are CD30 & CD15 positive, usually negative for CD20 & CD45.Nodular sclerosisMC subtype; usually stage I or ll disease frequent mediastinal involvementMore common in females, most patients young adults