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Composite Lymphoma : Hodgkin & SLL

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Reed-Sternberg (RS)-like cells can be seen in a wide variety of B-cell and T-cell non-Hodgkin lymphomas. Among B-cell lymphomas, they are most frequently encountered in chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) as well as follicular lymphomas.

Two patterns are encountered in CLL/SLL. 1) Prototypic case of CLL/SLL in which scattered RS cells are incidentally found admixed with small round lymphocytes with classic immunophenotype (CD5+, CD20+, CD23+, FMC7 -ve). The RS cells are usually CD30+, often CD15+, may co-express CD20, and are EBV-infected (positive for EBER-1, LMP-1).

2) CLL/SLL cases with Hodgkin-like Richter transformation which show nodules of classic Hodgkin lymphoma, separate from CLL foci, in which RS cells are found in background of polymorphous infiltrate.

About this Image: This low magnification view is from a 6.5 cm inguinal lymph node removed from an elderly male. About 60% of the lymph node was replaced by a diffuse proliferation of small lymphocytes with immunophenotype diagnostic of CLL/SLL. Several proliferation centers are seen in this field. The remainder of the lymph node had features of classic Hodgkin lymphoma.

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