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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.

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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

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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

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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

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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

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Figure 4
The amount of series R-S cells is more than 15 cells/HPF in LDCHL.

References

  1. Swerdlow SH, Campo E, Harris NL, Jaffe ES, Pileri SA, Stein H, et al. WHO Classification of Tumors of Haematopoietic and Lymphoid Tissues. 4 edition/2 volume. 2017. Lyon.
  2. Jaffe ES. Harris NL, Vadiman JW, et al. Hematopathology, Charpter 27, classical Hodgkin lymphoma, Elsevier ,2013.
  3. Tumors of lynyshoreticular system. In: Fletcher CM. Diagnostic Histopathology of Tumors. volume 2. 3rd edition. 2007. Elsevier.
  4. 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).
  5. Harry L. Ioachim , L. Jeffrey Medeiros. Lochim’s Lymph Node Pathology. 4 edition. 2008. Wolters Kluwer Health.