EBV-Positive NS-CHL Syncitial Variant, Grade II

Siba El Hussein, MD
2 min readSep 19, 2021

Lessons From The Friday Unknowns

Histologic sections of the lymph node specimen show a large lymph node extensively replaced by neoplasm.

There is pericapsular fibrosis and there are fibrous bands that extend into the neoplasm.

In some areas the neoplasm is nodular and the nodules are composed of many large neoplastic cells consistent with lacunar cells in a background of many histiocytes, eosinophils with relative lymphocyte depletion.

Areas of coagulative necrosis are also present, and these necrotic areas are surrounded by many neoplastic cells.

The large neoplastic cells are positive for CD30 and PAX-5 and negative for ALK–1, BOB1 and OCT-2.

CD30 stain
PAX5 stain

The large neoplastic cells are positive for Epstein–Barr virus encoded RNA (EBER).

These findings are supportive of the diagnosis of nodular sclerosis classic Hodgkin lymphoma, with syncitial features, grade II.

The term grade II is applied to cases showing one of the three following patterns:

(1) More than 25% of the nodules have a cellular composition consistent with the pleomorphic or reticular subtype of NS-CHL/LDV.

(2) More than 80% of the nodules show a fibrotic or fibrohistiocytic composition.

(3) More than 25% of the nodules contain numerous large bizarre or anaplastic cells, in the absence of depletion of the reactive small lymphoid component.

Link to digital slides slides: https://bit.ly/2YQqaNJ | Slides labeled case 1

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Siba El Hussein, MD

Hematopathology | Cytopathology | Molecular pathology | Digital pathology | Data science | Machine learning