《Slide 99.》Hodgkin lymphoma , Lymph node

A. Brief Descriptions：

1. Hokgdin lymphoma is characterized morphologically by the presence of distinctive neoplastic giant cells, RS cells, which induce the accumulation of reactive lymphocytes, histiocytes, and granulocytes.

2. Classification:

   1. Nodular sclerosis

   2. Mixed cellularity

   3. Lymphocyte predominance

   4. Lymphocyte depletion

B. Gross Findings：

1. Enlarged and encapsulated lymph noeds with fish flesh cut surfaces.

C. Micro Findings：

1. Diffuse effacement of lymph nodes by a heterogeneous cellular infiltrate.

2. Moderate amount of RS cells and Hodgkin cells.

3. Lacunar cells, mummified cells.

4. Background: benign-looking small lymphocytes, histiocytes.

5. Mild interstitial fibrosis and few bands of collagen (especially along vessels).

D. Others:

1. Reed-Sternberg cell (RS cell)

   1. Classic RS cell

      • Large (15~45m), binucleate or bilobed, with the two halves often appearing as “mirror-image” of each other.

      • Nucleus: may be multiple or multilobate, contains large, inclusion-like, owl-eyed nucleoli, generally surrounded by a clear halo, that are about the size of a small lymphocyte (5~7 m).

      • Cytoplasm: abundant amphophilic.

   2. Variants of RS cells (1)

      1. Mononuclear variants

         • Hodgkin cells.

         • A single round or oblong nucleus with a large inclusion-like nucleolus.

      2. Lacunar variants

         • Folded or multilobate nuclei surrounded by abundant pale cytoplasm which distrupted during the cutting of sections , leaving the nucleus sitting in an empty hole. 

         • Predominant in  nodular sclerosis type.

      3. Lymphocytic and histiocytic variants (L+H cells)

         • Polypoid nuclei resembling popcorn kernels, inconspicuous nucleoli, and moderately abundant cytoplasm.

         • Specific to the lymphocyte predominance subtype.

      4. Mummified cells

         • Degenerate L+H cells or RS cells.

         • Large cell with darkly staining eosinophilic cytoplasm and a dense pyknotic nucleus.

E. Reference：

1. Robbins Pathologic Basis of Disease, 6^th ed.  P.670-675.

　

 

 

【 Fig. 99-1 (LP)】Diffuse effacement of lymph node by  neoplastic lymphoid infiltrate.

　

 

 

【 Fig. 99-2 (LP)】Heterogeneous cellular infiltrate.

　

　

 

【 Fig. 99-3 (LP)】Neoplastic Hodgkin lymphoma in the background of lymphocytes and histiocytes.

　

 

【 Fig. 99-4 (HP)】Classical Reed-Sternberg cells with large "mirror-image" like nuclei and eosinophilic owl-eye nucleoli surrounded by a clear halo.

 

 

【 Fig. 99-5 (HP)】Lacunar cells with delicate folded nuclei surrounded by abundant pale cytoplasm.

　

 

 

【 Fig. 99-6 (HP)】Mummified cells with darkly staining eosinophilic cytoplasm and a dense pyknotic nucleus.