What is the immunophenotype of neoplastic cells in classical Hodgkin lymphoma?

Question

Accepted Answer

C. CD30+, CD15+, CD45−, CD20−. ## Immunophenotype of Classical Hodgkin Lymphoma

**Key Point:** Reed-Sternberg and Hodgkin cells in classical Hodgkin lymphoma are CD30^+^, CD15^+^, CD45^−^, and CD20^−^ (or weakly positive). This distinctive phenotype is crucial for diagnosis and distinguishes cHL from other lymphomas.

### Immunophenotypic Profile of cHL Neoplastic Cells

| Marker | Expression | Significance |
| --- | --- | --- |
| **CD30** | Positive (strong) | Activation marker; defining feature |
| **CD15** | Positive (75–85% of cases) | Myeloid marker; highly specific for cHL |
| **CD45 (LCA)** | Negative | Absent pan-leukocyte antigen |
| **CD20** | Negative or weak | B-cell marker; typically absent |
| **CD3** | Negative | T-cell marker; absent |
| **CD79a** | Negative or weak | B-cell marker; typically absent |
| **EBV (EBER)** | Variable (40–50% overall, higher in MC subtype) | In situ hybridization |
| **PAX5** | Weak or absent | B-cell transcription factor; reduced |

### Why This Phenotype Matters

1. **CD30+ CD15+:** Highly specific for cHL; distinguishes from primary mediastinal B-cell lymphoma (which is CD30+ but CD15−).
2. **CD45− CD20−:** Indicates loss of B-cell lineage markers despite B-cell origin (by clonality studies).
3. **Diagnostic Algorithm:** CD30+ in a background of inflammatory cells + CD15+ + CD45− + CD20− = cHL until proven otherwise.

**High-Yield:** The **CD30+ CD15+ CD45− CD20−** phenotype is the classic immunophenotype taught for cHL. Any deviation (e.g., CD20+ or CD15−) should prompt consideration of alternative diagnoses.

**Clinical Pearl:** Flow cytometry may be falsely negative for CD30 if the neoplastic cells are sparse; immunohistochemistry on tissue is more reliable. Always correlate with morphology.

**Mnemonic:** **"cHL = CD30 CD15 Negative for 45 and 20"** — Remember the positive markers (30, 15) and the negative ones (45, 20).

Answer

A. CD30−, CD15−, CD45+, CD20+

Answer

B. CD30+, CD15+, CD45+, CD20+

Answer

D. CD30+, CD15−, CD45+, CD20+

What is the immunophenotype of neoplastic cells in classical Hodgkin lymphoma?

Explanation

Immunophenotype of Classical Hodgkin Lymphoma

Immunophenotypic Profile of cHL Neoplastic Cells

Why This Phenotype Matters

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Marker	Expression	Significance
CD30	Positive (strong)	Activation marker; defining feature
CD15	Positive (75–85% of cases)	Myeloid marker; highly specific for cHL
CD45 (LCA)	Negative	Absent pan-leukocyte antigen
CD20	Negative or weak	B-cell marker; typically absent
CD3	Negative	T-cell marker; absent
CD79a	Negative or weak	B-cell marker; typically absent
EBV (EBER)	Variable (40–50% overall, higher in MC subtype)	In situ hybridization
PAX5	Weak or absent	B-cell transcription factor; reduced