Hodgkin Reed-Sternberg-Like Cells in Non-Hodgkin Lymphoma

Abstract

Reed-Sternberg cells (RSCs) are hallmarks of classic Hodgkin lymphoma (cHL). However, cells with a similar morphology and immunophenotype, so-called Reed-Sternberg-like cells (RSLCs), are occasionally seen in both B cell and T cell non-Hodgkin Lymphomas (NHLs). In NHLs, RSLCs are usually present as scattered elements or in small clusters, and the typical background microenviroment of cHL is usually absent. Nevertheless, in NHLs, the phenotype of RSLCs is very similar to typical RSCs, staining positive for CD30 and EBV, and often for B cell lineage markers, and negative for CD45/LCA. Due to different therapeutic approaches and prognostication, it is mandatory to distinguish between cHL and NHLs. Herein, NHL types in which RSLCs can be detected along with clinicopathological correlation are described. Moreover, the main helpful clues in the differential diagnosis with cHL are summarized.

Keywords: B cell lymphoma; CD30; Reed-Sternberg cell; Reed-Sternberg-like cell; T cell lymphoma; classic Hodgkin Lymphoma; lymphoma diagnosis; lymphoma diagnostics.

Figure 1

cHL: (A) Nodular pattern of growth with sclerosis in nodal cHL (hematoxylin/eosin, 0.5×; scale bar: 0.5 cm). (B) RSCs in a typical context of polymorphic infiltrate comprising small lymphocytes, histiocytes, plasma cells, and eosinophils (hematoxylin/eosin, 20×). RSCs (red arrows) with strong expression of CD30 (C), negativity for CD20 (D), and positivity for EBV/LMP1 (E) (immunostaining, 40×; scale bar: 50 µm).

Figure 2

ALK+ ALCL: (A) Diffuse pattern of growth in nodal ALK+ ALCL (hematoxylin/eosin, 5×; scale bar: 100 µm). (B) RSLCs (red arrows) in a polymorphic infiltrate comprising small lymphocytes and plasma cells (hematoxylin/eosin, 30×; scale bar: 50 µm). RSLCs (red arrows) with strong expression of CD30 (C), strong positivity for ALK (D), and CD4 (E) (immunostaining, 40×; scale bar 50 µm).

Figure 3

ALK− ALCL: (A) Diffuse pattern of growth in nodal ALK− ALCL (hematoxylin/eosin, 5×; scale bar: 100 µm). (B) RSLCs in a polymorphic infiltrate comprising small lymphocytes and eosinophils (hematoxylin/eosin, 30×; scale bar: 50 µm). RSLCs (red arrows) with expression of CD30 (C), positivity for CD4 (D) and for MUM1/IRF4 (E) (immunostaining, 40×; scale bar: 50 µm).

Figure 4

AITL: (A) Diffuse pattern of growth and marked proliferation of arborizing high endothelial venules in nodal AITL (hematoxylin/eosin, 5×; scale bar: 100 µm). (B) RSLCs (red arrows) in a polymorphic infiltrate comprising small lymphocytes, plasma cells, histiocytes, and eosinophils (hematoxylin/eosin, 30×, scale bar: 50 µm). RSLCs (red arrows) with expression of CD30 (C), negativity for CD4 in a context of small CD4+ lymphocytes (D) and positivity for BCL6 (E) in a context of small partially BCL6+ lymphocytes (immunostaining, 40×; scale bar: 50 µm).

Figure 5

F-PTCL. (A) Nodular pattern of growth in nodal F-PTCL (hematoxylin/eosin, 0.5×; scale bar: 0.5 cm). (B) Isolate RSLCs (red arrows) in a context of small lymphocytes (hematoxylin/eosin, 30×; scale bar: 50 µm). RSLCs (red arrows) weakly positive for CD30 (C), strongly positive for CD45/LCA (D), and for PAX5 (E) (immunostaining, 40×; scale bar: 50 µm).

Figure 6

DLBCL, NOS: (A) Diffuse pattern of growth in nodal DLBCL, NOS (hematoxylin/eosin, 5×; scale bar: 0.5 cm). (B) RSLCs (red arrows) in a context of medium-to-large lymphocytes (hematoxylin/eosin, 30×, scale bar: 50 µm). RSLCs (red arrows) with expression of CD30 (C), positivity for CD20 in a context of CD20+ medium-to large lymphocytes (D) and positivity for BCL6 in a context of BCL6+ medium-to large lymphocytes (E) (immunostaining, 40×; scale bar: 50 µm).

Figure 7

PMBL: (A) Diffuse pattern of growth in PMBL (mediastinal biopsy; hematoxylin/eosin, 5×; scale bar: 0.5 cm). (B) RSLCs (red arrows) in a polymorphic infiltrate comprising lymphocytes, histiocytes, in a context of sclerosis (hematoxylin/eosin, 30×; scale bar: 50 µm). RSLCs (red arrows) with expression of CD30 (C), positivity for CD23 in a context of CD23+ medium-to large lymphocytes (D), and for BCL6 (E) (immunostaining, 40×; scale bar: 50 µm).

Figure 8

PEL: (A) Small cellular aggregates in fibrinoid background with hypocellularity (peritoneal biopsy; hematoxylin/eosin, 5×; scale bar: 0.5 cm). (B) RSLCs (red arrows) in small aggregates of neoplastic cells (hematoxylin/eosin, 30×; scale bar: 50 µm). RSLCs (red arrows) with CD30 expression (C), strong HHV8 positivity (D), and CD45/LCA expression (E) in a context of medium-to large lymphocytes (immunostaining, 40×; scale bar: 50 µm).

Figure 9

FL: (A) Nodular pattern of growth with fibrosis in nodal FL (3b) (hematoxylin/eosin, 0.5×; scale bar: 0.5 cm). (B) RSLCs (red arrows) in a typical context of a polymorphic infiltrate comprising small T lymphocytes, FDCs and histiocytes (hematoxylin/eosin, 20×; scale bar: 50 µm). RSLCs (red arrows) with CD30 negativity (C), strong CD20 positivity (D), and BCL6 expression (E). (immunostaining, 40×; scale bar: 50 µm).