All of the following are characteristic histological features of classical Hodgkin lymphoma EXCEPT:
A. CD45+ (LCA) positivity of neoplastic cells
B. CD30+ and CD15+ immunophenotype of neoplastic cells
C. Hodgkin cells and Reed-Sternberg cells with mirror-image nuclei
D. Inflammatory background with small lymphocytes, eosinophils, and plasma cells
Explanation
Diagnostic Criteria of Classical Hodgkin Lymphoma
Key Point
Classical Hodgkin lymphoma (cHL) is defined by the presence of Hodgkin cells and Reed-Sternberg (RS) cells within a rich inflammatory background. The neoplastic cells are typically CD30+ and CD15+, but notably they are CD45-negative (LCA-negative).
Immunophenotypic Profile of Neoplastic Cells
Table
Feature
Status
Significance
CD30
Positive
Marker of activation; required for diagnosis
CD15
Positive
Present in ~75–85% of cHL cases
CD45 (LCA)
Negative
Distinguishes neoplastic cells from background lymphocytes
CD3, CD20
Negative/Weak
Loss of pan-T or pan-B cell markers
CD20
Weak/Negative
Helps differentiate from B-cell lymphomas
EBV (EBER)
Positive
Present in ~40% of cases (variable by subtype)
High-YieldNEET PG
CD45 (LCA) negativity is a cardinal feature that separates cHL neoplastic cells from the surrounding reactive lymphocyte population. This is a critical diagnostic criterion.
Morphological Features
1.
Hodgkin cells: Large cells with prominent nucleoli, abundant cytoplasm, and moderate pleomorphism.
2.
Reed-Sternberg cells: Multinucleated giant cells with "mirror-image" or "owl's-eye" nuclei, thick nuclear membranes, and prominent eosinophilic nucleoli.
3.
Background: Predominantly T lymphocytes (CD8+ > CD4+), eosinophils, plasma cells, histiocytes, and fibroblasts — the neoplastic cells comprise <1% of the cellularity.
Clinical Pearl
The scarcity of neoplastic cells in a sea of inflammation is a hallmark of cHL and explains why morphology alone can be challenging; immunohistochemistry is essential for diagnosis.
Why CD45 Positivity is Wrong
CD45 (leukocyte common antigen) is expressed on all hematopoietic cells. Hodgkin and Reed-Sternberg cells in classical Hodgkin lymphoma are CD45-negative, which is part of their aberrant immunophenotype and helps distinguish them from reactive lymphocytes and other lymphomas. CD45 positivity would be seen in the background inflammatory cells, not the neoplastic cells themselves.
Robbins 10e Ch 13
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