Download e-book for iPad: Lymphomas 1: Including Hodgkin’s Disease by Barbara H. Tindle (auth.), John M. Bennett (eds.)

By Barbara H. Tindle (auth.), John M. Bennett (eds.)

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The cells in this tumor are a heterogeneous combination of plasma cells, small lymphocytes and mainly plasmacytoid lymphocytes, the latter with nuclei resembling those of lymphocytes, but eccentric and associated with abundant cytoplasm which is at least moderately pyroniphilic. Periodic acid Schiff positive inclusions may be observed in cytoplasm as Russell bodies [290] or in the nucleus as Dutcher bodies [291]. Immunological markers demonstrate a monoclonal pattern of the cellular proliferation.

The diagnosis presents little or minimal difficulty when the lesion presents in classical or typical form in lymph node (Figure 20). In the most easily recognized form, the lymph node architecture is largely obliterated. Follicular centers may remain; however, the sinusoidal and other interfollicular components are replaced by broad thick birefringent collagen bands which extend from a thickened capsule and surround cellular nodules which contain lacunar cells. The difficulties in diagnosis relate to the variable degree of sclerosis, which is observed in different lymph nodes and in the cellular variability of the cellular nodules containing the lacunar cells.

Lukes describes two types of reticular Hogkin's disease [115]. In one type, the cellularity includes diagnostic Reed-Sternberg cells in great abundance. In the second type, the pleomorphic cell type is so abundant that the process has been aptly described as sarcomatous. A problem in distinguishing subtypes of Hodgkin's disease occurs when the array of pleomorphic cells is confused with a proliferation of lacunar cells having large nucleoli. The differential diagnosis on a histological basis may be difficult between reticular Hodgkin's disease, histiocytic lymphoma (lymphoma of macrophages) and immunoblastic sarcoma.

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Lymphomas 1: Including Hodgkin’s Disease by Barbara H. Tindle (auth.), John M. Bennett (eds.)


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