On the present pictures I can neither confirm nor disclaim your diagnosis. I do not see convincing HRS cells and there is no convincing CD30-positivity. In the CD20 there are indeed some blasts. Please add convincing pictures inkl. scanning magn. and perform additional examinations like LMP1 and PAX5.

Thank you for your comment. We were also confused with weak CD30 positivity. CD30 worked well on positive probe. On the other hand, there is no fibrosis in the lymph node. We dont have LMP1 and PAX5 yet. I will upload some more pictures, and send the case to someone more equiped.

Dear Dr.Dmitrovic, please allow me a general comment on posting of immunohistochemical incubations. With each Ab we need an overview, low power, and one or more high power images in order to appreciate the morphology of the positive cells.  
Now to your case: The panoramic image,displays a certain nodularity, however the broad bands of colloagen characteristic for HL NS are not seen. The appearances on conventional stains, HE and Giemsa are suggestive of HL, but not entirely convincing. The positivity for CD15 in an argument in favour of HL. The result of CD30 is disturbing, but there seems to be a dot like positivity in some of the large mono nucleated cells. It would be nice to see it on high power. It might be also worth - while to repeat the reaction. Has this node been processed in your laboratory? The result of the CD 30 incubation could be due to technical reasons ? Could you please post the positive control for comparison.

I agree with dr Tzankov and dr Hurwitz, but I would like to comment CD20 positivity. According to my experience CD20 may be positive but it is usually less intensive and present only on a minority of the neoplastic cells. Neoplastic cells are usually surrounded by CD3 positive lymphocytes which I didn't observe in these photos. Could you repeat CD15?

Thanks Marin, I forgot to mention this point.

I agree with previous comments - CD30 should be better documented, however there is a dot-like positivity in the Golgi are which is suggesting that the staining is specific although quite weak. In general CD20 positivity is seen in approx. 15% of Hodgkin cases but CD15 positivity is extremely rare in B-cell NHL.

CD79a for further work-up could be helpful, being consistently negative in classical HL. CD3 should always be paired with CD20, too (both for the rosetting phenomenon and for a lot of uexpected surprises that sometimes happen in such polymorphic infiltrates).  
 
CD30, as Dr.Hurwitz mentioned, looks specific due to the large perinuclear granules, but the typical membrane component is missing. Most probably, it is some kind of processing atrefact and could be sometimes put right by a longer microwave demasking.  
 
Concerning nodular sclerosis, it doesn't seem to meet the required 3 cryteria (nodularity, band-type circular collagen fibrosis & lacunar cells, at least 2 of them should be present), capsula is not fibrotic. Faint nodularity is allowed in mixed cellularity.  
 
Finally, is this the primary site or there are tumor masses elsewhere, particularly in mediastinum? Phenotype CD30+CD15+CD20+++ could be seen in gray-zone lymphomas.

Thank you all. I will upload some more pictures of CD3 (for rosetting phenomenon) and CD30 positive probe. We are runing one more CD30 IHK together with CD79a.

Thanks Branco for the information we will wait.

I have uploaded some more pictures: re-run of the CD30 with the same Golgi weak positivity, CD30 positive probe, CD79a (negative) and CD3 with some rosetting.

Clinical data about the case: acute lymphadenopaty of the left neck area only. Cytology of the left supraclavicullar lymph node: Hodgkin cells, some RS-like cells and eosinophils.

Thank you for the additional images.  
 
At scanning magnification there is a large "stellate" necrosis like in some seldom variants of NS cHL (classical Hodgkin lymphoma). The additional images (CD30, CD3 3 and CD79a 2) are in support of your initial diagnosis, as is the positivity for CD15. The EBV status should be analyzed (LMP-1), since a positivity would be a convincing argument for cHL. Otherwise, based on the present information, I would only strongly suspect cHL.

Thank you all.