Which histological feature best distinguishes classical Hodgkin lymphoma (cHL) from nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL)?

Question

Accepted Answer

D. CD20 positivity of neoplastic cells. ## Distinguishing cHL from NLPHL

### Key Histological Differences

**Key Point:** CD20 expression is the most reliable immunophenotypic discriminator between cHL and NLPHL. Classical Hodgkin lymphoma cells are CD20-negative, whereas NLPHL cells (LP cells) are CD20-positive.

### Immunophenotypic Profile Comparison

| Feature | Classical HL | NLPHL |
|---------|-------------|-------|
| **CD20** | Negative | **Positive** |
| **CD45** | Negative | Negative |
| **CD30** | Positive | Negative/weak |
| **CD15** | Positive | Negative |
| **EBV** | Often positive | Negative |
| **CD4+ T-cell background** | Abundant | Sparse |

### Morphological Context

**High-Yield:** Both cHL and NLPHL contain abnormal cells (Hodgkin cells and Reed-Sternberg cells in cHL; LP cells in NLPHL) surrounded by reactive lymphocytes, eosinophils, and plasma cells. However, the immunophenotype is the gold standard for distinction.

### Why CD20 Matters

**Clinical Pearl:** CD20 positivity in NLPHL cells makes them B-cell derived and explains why NLPHL:
- Has a better prognosis than cHL
- May respond to rituximab (anti-CD20 monoclonal antibody)
- Shows a different clinical behavior (lower stage at presentation, better survival)

### Mediastinal Involvement Pattern

**Tip:** While mediastinal involvement is common in cHL (especially nodular sclerosis subtype), it is rare in NLPHL. However, this is an epidemiological feature, not a definitive histological discriminator. The immunophenotype remains the gold standard.

[cite:Robbins 10e Ch 13]

Answer

A. Involvement of mediastinal lymph nodes

Answer

B. Presence of Hodgkin and Reed-Sternberg cells

Answer

C. Background of small lymphocytes with eosinophils and plasma cells

Which histological feature best distinguishes classical Hodgkin lymphoma (cHL) from nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL)?

Explanation

Distinguishing cHL from NLPHL

Key Histological Differences

Immunophenotypic Profile Comparison

Morphological Context

Why CD20 Matters

Mediastinal Involvement Pattern

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Feature	Classical HL	NLPHL
CD20	Negative	Positive
CD45	Negative	Negative
CD30	Positive	Negative/weak
CD15	Positive	Negative
EBV	Often positive	Negative
CD4+ T-cell background	Abundant	Sparse