Which subtype of classical Hodgkin lymphoma is most common and is strongly associated with EBV infection?

Question

Accepted Answer

A. Mixed cellularity. ## EBV Association and Subtype Distribution in cHL

**Key Point:** Mixed cellularity Hodgkin lymphoma (MC-HL) shows the strongest association with EBV infection, particularly in developing countries and immunocompromised patients. However, nodular sclerosis is the most common subtype overall.

### Classical Hodgkin Lymphoma Subtypes

| Subtype | Frequency | EBV Association | Stage at Diagnosis | Geographic Pattern |
| --- | --- | --- | --- | --- |
| **Nodular Sclerosis** | 60–70% | Weak (10–40%) | Early (I–II) | Developed countries |
| **Mixed Cellularity** | 15–25% | Strong (75–95%) | Advanced (III–IV) | Developing countries |
| **Lymphocyte-Rich** | 5% | Weak | Early | Rare |
| **Lymphocyte-Depleted** | <5% | Variable | Advanced | Rare |

### EBV and Mixed Cellularity HL

1. **EBV Positivity:** 75–95% of cases, especially in developing nations and HIV+ patients.
2. **Mechanism:** EBV-driven proliferation of neoplastic cells; latency type II or III.
3. **Clinical Significance:** Associated with older age, advanced stage, and worse prognosis if untreated.
4. **Geographic Variation:** Highest in Central America, Africa, and Southeast Asia.

**High-Yield:** Nodular sclerosis is the most common subtype worldwide (60–70%), but mixed cellularity has the strongest EBV link and is more common in resource-limited settings.

**Mnemonic:** **"MC-HL = Most EBV-driven"** — Mixed Cellularity shows the strongest EBV association.

**Clinical Pearl:** In a young patient from a developed country with early-stage HL, think nodular sclerosis. In an older patient from a developing country or an HIV+ patient with advanced HL, think mixed cellularity with EBV+.

Answer

B. Lymphocyte-rich

Answer

C. Nodular sclerosis

Answer

D. Lymphocyte-depleted

Which subtype of classical Hodgkin lymphoma is most common and is strongly associated with EBV infection?

Explanation

EBV Association and Subtype Distribution in cHL

Classical Hodgkin Lymphoma Subtypes

EBV and Mixed Cellularity HL

Practice similar questions

Join our NEET PG community

Subtype	Frequency	EBV Association	Stage at Diagnosis	Geographic Pattern
Nodular Sclerosis	60–70%	Weak (10–40%)	Early (I–II)	Developed countries
Mixed Cellularity	15–25%	Strong (75–95%)	Advanced (III–IV)	Developing countries
Lymphocyte-Rich	5%	Weak	Early	Rare
Lymphocyte-Depleted	<5%	Variable	Advanced	Rare