Hodgkin’s lymphoma within the Rye classification

• Reed-Sternberg cells

  • “Classic” RS cells are large cells with abundant amphophilic cytoplasm and a mirror image binucleate or bilobed nucleus

  • Nucleus has large eosinophilic to amphophilic inclusion-like nucleoli surrounded by a clear halo (“Owl’s eyes”)

  • RS cells are admixed with a non-specific background of inflammatory cells (lymphocytes, plasma cells, eosinophils, macrophages)

  • Considered to be the neoplastic element in HD

  • RS cell variants

    • Lacunar: associated with nodular sclerosing Hodgkin’s

    • Popcorn (lymphohistiocytic, L + H): associated with lymphocyte predominant Hodgkin’s

    • Multinucleate

    • Mononuclear

• Rye classification

  • Lymphocytic predominant

    • Mature lymphocytes and a variable number of benign histiocytes

    • Few eosinophils, neutrophils, or plasma cells

    • Usually no fibrosis or necrosis

    • Few “classic” RS cells, many more L + H variant

    • Easily mistaken for NH lymphocytic lymphoma

    • Males <>

  • Mixed cellularity

    • Diffuse heterogeneous infiltrate of mature lymphocytes, eosinophils, plasma cells, and benign histiocytes

    • May see small areas of necrosis and fibrosis

    • Many more classical RS cells

    • Males <>

    • More often disseminated with systemic symptoms and worse prognosis than lymphocyte predominant subtype

  • Lymphocyte depletion

    • Lack of histiocytes and lymphocytes, few classical RS cells

    • Necrosis and fibrosis may be prominent

    • Occurs more in older patients with disseminated disease and systemic symptoms

    • Worst prognosis

  • Nodular sclerosis

    • Varying proportions of lymphocytes, plasma cells, and eosinophils

    • Lacunar variant of RS cells more common than classic RS cells

    • Variable degree of fibrosis with birefringent bands of collagen dividing the nodes into circumscribed nodules

    • Most common form of HD and only form more common in women

    • Tends to be in lower cervical, supraclavicular, and mediastinal nodes in young patients

    • Excellent prognosis

Category: Medical Subject Notes , Pathology Notes