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Hodgkin Lymphoma : Unusual Patterns

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Some cases of Hodgkin lymphoma have unusual histologic features that may mimic other malignant or benign entities.

Eosinophilic infiltrate may be prominent either as scattered individual cells (as seen here) or as eosinophilic microabscesses. Such cases may be misdiagnosed as langerhans cell histiocytosis, hypersensitivity reaction, or allergic granulomatosis.

Other rare histologic patterns include:

  • tumor limited to interfollicular region (frequent in lymphocyte-rich subtype)
  • sinusoidal involvement mimicking anaplastic large cell lymphoma
  • involvement of mainly germinal centers (resembles NLPHL)
  • plasma cell infiltrate and regressed germinal centers resembling Castleman disease
  • aggregates of foamy macrophages, monocytoid B cells, mast cells, or follicular dendritic cells
  • spindle cell proliferation resembling fibrosarcoma, pleomorphic sarcoma, or follicular dendritic cell tumor
  • non-caseating granulomas in tissues involved and unaffected by Hodgkin lymphoma

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