## Histological Subtypes of Hodgkin Lymphoma **Key Point:** Nodular sclerosis is the most common histological subtype of classical Hodgkin lymphoma (cHL), accounting for approximately 60–70% of cases in developed countries. ### Frequency Distribution | Subtype | Frequency | Key Features | Prognosis | |---------|-----------|--------------|----------| | **Nodular sclerosis** | 60–70% | Lacunar cells, collagen bands, mediastinal involvement | Favorable | | Mixed cellularity | 15–25% | Numerous RS cells, diffuse infiltrate, no nodules | Intermediate | | Lymphocyte-rich | 5% | Abundant small lymphocytes, few RS cells | Favorable | | Lymphocyte-depleted | 1–5% | Numerous RS cells, sparse lymphocytes | Poor | **High-Yield:** Nodular sclerosis typically presents in young adults (teens to 40s) with **mediastinal involvement** — a hallmark feature that helps distinguish it from other subtypes. ### Clinical Correlations **Clinical Pearl:** Nodular sclerosis frequently involves the **anterior mediastinum**, which may present as a mediastinal mass on chest X-ray even before lymphadenopathy is clinically apparent. This is why a chest imaging study is part of the initial workup. **Mnemonic:** **NSMCLD** = Nodular Sclerosis, Mixed Cellularity, Lymphocyte-Rich, Lymphocyte-Depleted (in order of frequency). ### Why Nodular Sclerosis is Most Common The nodular sclerosis subtype: - Arises from germinal center B cells - Shows characteristic fibrous bands dividing the lymph node into nodules - Contains lacunar cells (RS cell variants in formalin-fixed tissue) - Has the best prognosis among classical HL subtypes when treated appropriately **Warning:** Do not confuse nodular sclerosis with nodular lymphocyte-predominant HL (NLPHL), which is a separate entity with a different cell of origin (T-cell rich background) and better prognosis.
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