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Case History

22-year-old female with hilar and mediastinal lymphadenopathy, FNA of mediastinal lymph node.

What stains would you order to further work up the case?

A. Pax-8, WT-1
B. CD15, CD30
C. CK7, CK20
D. Gata-3, Mammaglobin


 Herndon22Case2 Herndon22Case3

 The correct answer is B. CD15, CD30


The diff quik stain shows a polymorphous lymphoid background with predominately small mature appearing lymphocytes, occasional histiocytes and rare large atypical lymphoid cells (Reed-Sternberg cells), morphologically compatible with Classic Hodgkin’s lymphoma. Reed-Sternberg cells show strong nuclear staining for CD15, strong cytoplasmic staining for CD30, and dim nuclear staining for Pax-5. Classic Hodgkin’s lymphoma can be sub classified into nodular sclerosing, lymphocyte rich, lymphocyte depleted, and mixed cellularity based on the non-neoplastic background cells and stroma. Classic Hodgkin’s lymphoma has a bimodal age distribution with peaks at 15-35 years old, and a second peak around 50-70 years of age. With current stage adapted therapy there is an 80-90% cure rate.

Case contributed by: Geoffrey Herndon, D.O. PGY3, UAB Pathology