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Nodular sclerosis classical Hodgkin lymphoma grade 2: A diagnostic challenge to the cytopathologists
Author(s) -
Sharma Sudha,
Dey Pranab,
Mitra Suvradeep,
Rajwanshi Arvind,
Nijhawan Raje,
Srinivasan Radhika,
Gupta Nalini,
Das Ashim
Publication year - 2017
Publication title -
cancer cytopathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.29
H-Index - 57
eISSN - 1934-6638
pISSN - 1934-662X
DOI - 10.1002/cncy.21799
Subject(s) - medicine , lymphoma , nodular sclerosis , hodgkin lymphoma , radiology , pathology , dermatology
BACKGROUND Grade 2 nodular sclerosis classical Hodgkin lymphoma (NSCHL) is less common than grade 1 lymphoma and has a worse overall prognosis. To the best of the authors' knowledge, no study of a large series of cases has been performed until now. The objective of this study was to assess the diagnostic efficacy of cytology for grade 2 NSCHL versus grade 1 NSCHL and study the morphological features of grade 2 NSCHL in fine‐needle aspiration cytology (FNAC). METHODS Fifteen of 51 histopathology‐proven cases of NSCHL (18 FNAC procedures) were grade 2, and 36 were grade 1. The efficacy of FNAC for detecting grade 1 and 2 NSCHL was assessed, and the frequency of misdiagnosis was compared. The clinical details and cytomorphological features of grade 2 NSCHL were studied in detail. RESULTS Among the grade 1 NSCHL patients, 58.4% were diagnosed with Hodgkin lymphoma (HL) or had findings suggestive of HL, whereas 20% of the grade 2 patients were diagnosed HL or suggestive of HL. Two cases of grade 2 NSCHL were misdiagnosed as anaplastic large cell lymphoma, and 4 were misdiagnosed as malignant neoplasms. Grade 2 NSCHL cases showed clusters and sheets of mononuclear, multinucleated, and bizarre cells, with some cases showing a suppurative background. However, extensive searching showed occasional Reed‐Sternberg (RS) cells in most of the cases, and lacunar cells were seen in 12 cases. CONCLUSIONS The diagnostic efficacy of FNAC is much lower for grade 2 NSCHL versus grade 1 NSCHL. The search for an occasional RS cell and the identification of lacunar cells can provide a clue for the diagnosis. Cancer Cytopathol 2017;125:104–113. © 2016 American Cancer Society.