Lymphoma and plasma cell neoplasms
Hodgkin lymphoma
Lymphocyte depleted classical Hodgkin lymphoma

Author: Dragos Luca, M.D. and Lauren B. Smith, M.D. (see Authors page)

Revised: 21 March 2017, last major update August 2011

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PubMed Search: "Lymphocyte depleted" classical Hodgkin lymphoma

Cite this page: Lymphocyte depleted classical Hodgkin lymphoma. PathologyOutlines.com website. http://pathologyoutlines.com/topic/lymphomanonBlymphocytedepleted.html. Accessed September 22nd, 2017.
Definition / general
  • LDCHL is a diffuse subtype of classic Hodgkin lymphoma (CHL) rich in Hodgkin Reed-Sternberg (HRS) cells or depleted in nonneoplastic lymphocytes (WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues, 4th Edition, Lyon 2008)
Terminology
  • Most historic cases are actually anaplastic non-Hodgkin lymphoma, diffuse large B cell lymphoma or syncytial variant of nodular sclerosing Hodgkin lymphoma (Leuk Lymphoma 2009;50:937)
Epidemiology
  • < 1% of all classic Hodgkin lymphoma in Western countries (rarest subtype); more common in developing countries
  • Often HIV associated
  • Median age 30 - 37 years
  • Male predominance (60 - 75%)
Sites
  • 90% have subdiaphragmatic disease or organomegaly
  • Predilection for retroperitoneal lymph nodes, abdominal organs and bone marrow
  • Marrow involvement is common (54%); 50% have peripheral adenopathy
Clinical features
Treatment
  • Aggressive course prior to modern therapy, still seen in parts of Europe and developing countries
  • Comparable with other classic Hodgkin lymphoma in Western countries
  • Poor prognosis in HIV cases
  • All Classical Hodgkin lymphoma subtypes are treated similarly with either chemotherapy alone or chemotherapy plus external beam radiation
Microscopic (histologic) description
  • Either diffuse fibrosis or reticular forms

Diffuse fibrosis form
  • Complete effacement of nodal architecture by abundant disorderly connective tissue with PAS+ fibrinoid material and hypocellular background
  • Rare Reed-Sternberg cells
  • Classify as nodular sclerosis classic Hodgkin lymphoma if nodular and sclerotic

Reticular form
  • No disorderly connective tissue, numerous bizarre Reed-Sternberg cells, often in sheets, with few lymphocytes

Bone marrow
  • Rare Reed-Sternberg cells in amorphous, nonbirefringent eosinophilic background material and inflammatory infiltrate
  • Multiple sections / levels often required for diagnosis
  • Uninvolved marrow is normocellular with increased eosinophils (Am J Surg Pathol 1986;10:219)

  • May resemble mixed cellularity classic Hodgkin lymphoma
  • Sarcomatous pattern with pleomorphic HRS cells difficult to differentiate from anaplastic large cell lymphoma
  • May have coagulative necrosis or sinusoidal invasion
Microscopic (histologic) images

Images hosted on PathOut server:

Diffuse fibrosis and a Reed-Sternberg cell

Numerous Hodgkin cells in a background of fibrosis



Images hosted on other servers:

Various images

Reticular form (also called sarcomatous)

Diffuse fibrosis form


Reed-Sternberg cell staining

Other images

Positive stains
Negative stains
Differential diagnosis