Clinical Image
Deciphering the Difficulty for Pathologic Diagnosis of Hodgkin Lymphomas
Meigang Zhu and Ke-seng Zhao*
Department of Pathology and Pathophysiology, Southern Medical University Guangzhou, China
*Corresponding author: Ke-seng Zhao, Department of Pathophysiology, Southern Medical University, China
Published: 26 Mar, 2018
Cite this article as: Zhu M, Ke-seng Zhao. Deciphering the
Difficulty for Pathologic Diagnosis of
Hodgkin Lymphomas. Clin Oncol. 2018;
3: 1450.
Clinical Image
Hodgkin lymphoma (HL) is composed of 30% of lymphoma. It is difficult for pathologic
diagnosis because of a variety of morphology in Reed- Sternberg cells (R-S cell) and reactive
inflammatory cells on the background [1-3]. According to our experience, following points may
help the diagnosis of HL
1. The size of diagnostic R-S cell is 2 times than one B- immunoblast or one histocyte in the same
field of section (Figure 1) [4].
2. The diagnostic R-S cell usually has 2 nuclei, which includes big nucleolus. The size of nucleolus
in diagnostic R-S cell is equivalent to the size of one erythrocyte or one small lymphocyte (about 5
μm) in the same field of section (Figure 2) [4].
3. The appearance of series R-S cells well helps to diagnose HL. A series R-S cells includes more
than 2 types of R-S cells, i.e. One is diagnostic R-S cells (with 2 nuclei) served as a marker, others are
one or more variant R-S cells, including mononuclei, multi nuclei, lacuner, mummigied R-S cells
(Figure 3) [4].
4. Quantitative indicator of R-S cell helps for classified diagnosis of CHL. I.e. 5-15 R-S cells/
HPF for Mixed Cellular CHL (MCCHL), > 15 cells/HPF for Lymphocyte Depleted CHL (LDCHL)
(Figure 4). < 5 cells/HPF for Lymphocyte Rich CHL (LRCHL) [2,5].
Figure 1
Figure 1
The size of a diagnostic R-S cell (A) is 2 times than a histocyte (B) Or a B-immunoblast (C) in the same field.
Figure 2
Figure 2
The size of diagnostic R-S cell nucleolus (arrow) is equivalent to the size of small lymphocytes around the R-S cell.
Figure 3
Figure 3
Series R-S cells includes A- diagnostic R-S cells (two nuclei),
B-variant R-S cell with mononucleus; C- variant R-S cell with multi- nuclei.
Figure 4
References
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- Jaffe ES. Harris NL, Vadiman JW, et al. Hematopathology, Charpter 27, classical Hodgkin lymphoma, Elsevier ,2013.
- Tumors of lynyshoreticular system. In: Fletcher CM. Diagnostic Histopathology of Tumors. volume 2. 3rd edition. 2007. Elsevier.
- Mei gang Zhu, James Huang, Differential Diagnosis between Benign and Malignant of Lymphoid Issues Proliferative Lesions, Guangdong Seience & Technology Press, 2012; 314~333 (In Chinese).
- Harry L. Ioachim , L. Jeffrey Medeiros. Lochim’s Lymph Node Pathology. 4 edition. 2008. Wolters Kluwer Health.