Lymphocyte Depleted Hodgkin Lymphoma

Comments:
Lymphocyte depleted classic Hodgkin lymphoma (cHL) is the least common subtype, accounting for < 1% of all Hodgkin lymphomas. It is more frequent in older patients, HIV-positive individuals, and in lower-income countries. The prognosis is less favorable than other histologic subtypes.

The patients present with fever and advanced disease (stage III or IV) with involvement of abdominal organs and bone marrow, resulting in pancytopenia or lymphopenia, hepatomegaly, and no peripheral lymphadenopathy. Reed-Sternberg (RS) cells are infected with EBV in about 90% of cases.

Two patterns have been recognized - diffuse fibrosis type and reticular type. The diffuse fibrosis type is hypocellular and shows relatively abundant atypical RS cells which may appear sarcomatous, atypical mononuclear cells and a sparse mixed inflammatory infiltrate with only few lymphocytes in a background of heavy reticulin fibrosis. This case involved liver; note the normal liver parenchyma at the bottom of the image. The atypical RS cells are evident even at this low magnification.