21 yrs old lady underwent supraclavicular and mediastinal lymph node biopsy. Tumor is located in mediastinal lymph nodes only.  
HISTO: There are some nodularity with confluent "geographic" necrotic- "granulomatous" areas in the lymph node. There are "solid" medium- large cell collections aroud necrotic zones, in sinuses and in the nodules. The scattered bilobed cells are present.  
IH: Medium- large cells: PAN CK/BCL-6/ALK1/EMA/EBV LMP1/CD 20/CD4/CD3/LCA(-), CD15(+), CD30(+), single cells- Granzym B (+).  
 
DIFFERENTIAL: ALCL ALK1- CD15+ >>>>> CLASSIC HOGKIN'S LYMPHOMA NS (GRADE II).  
Thank you for participating.

anpo 2006-05-26 19:57	I think that it is the syncytial variant of NS Hodgkin lymphoma. I mail you a pdf of a similar case description (Arch Pathol Lab Med,2000, 124,1837
ugnius 2006-05-27 08:56	Thank you dr.Anna. It's strange, that populations of tumor cells tend to be medium and typical RS or etc. cells are single ones.
anpo 2006-05-27 12:32	I have seen a couple of these cases, they have very characteristic morphology, clinically they may be more aggressive, but still behave as Hodgkin lymphoma.
dirnhofer 2006-05-29 05:14	chl is clear; subtype could also be - besides syncytial variant of ns - lymphocyte depleted.
ugnius 2006-05-29 07:01	Do you believe in depletion variant with single giant RS cells and in general???
hurwitz 2006-05-29 16:15	I agree with HL, nodular sclerosis, Grade 2, which equals lymphocyte depletion. large areas of necrosis are an additional indication for aggressive disease.
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