IHC stains: Large atypical cells are positive for CD30, CD15, PAX5 (weak), MUM1, LMP1, and negative for CD45, CD20, CD79a, ALK1.
Diagnosis: Classical Hodgkin Lymphoma, lymphocyte-depleted subtype
This is the rarest CHL subtype (<1% of cases in Western countries). 60-75% of patients are male and the median age
ranges from 30-37 years. This subtype is often associated with HIV infection and is seen more often in developing countries
LDCHL has a predilection for retroperitoneal lymph nodes, abdominal organs, and bone marrow, and presents at a more advanced stage (III-IV) and with B symptoms than the other subtypes.
Histopathology is variable, a unifying feature is the relative predominance of HRS cells in relation to the background lymphocytes. One pattern may resemble mixed cellularity but compared with increased numbers of prototypic HRS cells. In some cases pleomorphic HRS cells may predominate, producing a sarcomatous appearance. These cases may be difficult to differentiate from anaplastic forms of large cell non-Hodgkin lymphoma. Another pattern is haracterized by diffuse fibrosis with or without a proliferation of fibroblasts and only a few HRS cells.
The tumor cells are positive for CD30, CD15, PAX5, negative for CD45, CD20(mostly), CD79a, same as in the other subtypes of classical HL. Most HIV+ cases are EBV infected and stain positively for LMP1.
Prior to modern therapy, LDCHL was aggressive and it has remained so in developing countries. In the
US and UK, the course is comparable to other cHL subtypes of similar stage. Poor prognosis is seen in HIV-related cases.
Diagnosis: Classical Hodgkin Lymphoma, lymphocyte-depleted subtype
This is the rarest CHL subtype (<1% of cases in Western countries). 60-75% of patients are male and the median age
ranges from 30-37 years. This subtype is often associated with HIV infection and is seen more often in developing countries
LDCHL has a predilection for retroperitoneal lymph nodes, abdominal organs, and bone marrow, and presents at a more advanced stage (III-IV) and with B symptoms than the other subtypes.
Histopathology is variable, a unifying feature is the relative predominance of HRS cells in relation to the background lymphocytes. One pattern may resemble mixed cellularity but compared with increased numbers of prototypic HRS cells. In some cases pleomorphic HRS cells may predominate, producing a sarcomatous appearance. These cases may be difficult to differentiate from anaplastic forms of large cell non-Hodgkin lymphoma. Another pattern is haracterized by diffuse fibrosis with or without a proliferation of fibroblasts and only a few HRS cells.
The tumor cells are positive for CD30, CD15, PAX5, negative for CD45, CD20(mostly), CD79a, same as in the other subtypes of classical HL. Most HIV+ cases are EBV infected and stain positively for LMP1.
Prior to modern therapy, LDCHL was aggressive and it has remained so in developing countries. In the
US and UK, the course is comparable to other cHL subtypes of similar stage. Poor prognosis is seen in HIV-related cases.