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Some cases of nodular sclerosis classic Hodgkin lymphoma show cellular clusters or even confluent sheets of lacunar cells. Foci of necrosis may be present. These cases have been referred to as syncytial variant of nodular sclerosis cHL, which is included in the grade II category. When this feature is pronounced, they may be misdiagnosed as anaplastic large cell lymphoma, metastatic carcinoma, germ cell tumor, or even thymoma (if the tumor location is mediastinal).

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