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Distinctive patterns of marrow involvement by classic Hodgkin lymphoma are clues for diagnosis and subtyping

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Abstract

Classic Hodgkin lymphoma (CHL) is a lymphoid neoplasm deriving from B cells in a rich inflammatory background. There are four histological subtypes with different epidemiological features. Bone marrow involvement by CHL is infrequent, and subtyping CHL from the bone marrow is not suggested as there might be discordant histopathology between the primary tumors and bone marrow specimens. In this study, we aimed to identify the histopathological features of bone marrow involved by CHL and tried to correlate these features with their subtypes. Among the 23 recruited cases, the frequencies of mixed cellularity (MC; 48%, 11/23) and nodular sclerosis (NS; 44%, 10/23) were similar. There were two patterns of marrow involvement: pattern A (fibrous), space-occupying lesions with alternating hypo- and hypercellular areas against a fibrotic background with dilated sinusoids and pattern B (histiocyte-rich), ill-defined granuloma-like lesions in which histiocytes merged with normal hematopoietic and inflammatory cells. Pattern A was more frequent in patients with CHL-NS than CHL-MC (100% vs. 18.2%; p < 0.001). Diagnostic Hodgkin cells and Reed-Sternberg (HRS) cells were identified in all cases, while HRS variant lacunar cells were occasionally discovered, particularly in the CHL-NS subtype (NS 100% vs. MC 9%; p < 0.001). The frequency of EBV association was higher in MC (64%) than that in NS (36%) subtype, but not statistically significant. Of the two patterns of marrow involvement, pattern A was more commonly associated with the NS subtype and less frequently associated with EBV. Recognizing the patterns of marrow involvement is important for diagnosis and may contribute to the subtyping of CHL.

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Author information

Authors and Affiliations

  1. Department of Pathology and Laboratory Medicine, Taichung Veterans General Hospital, Taichung, Taiwan

    Hsin-Ni Li & Ren Ching Wang

  2. Department of Nursing, National Taichung University of Science and Technology, Taichung, Taiwan

    Hsin-Ni Li

  3. Department of Nursing, Hung Kuang University, Taichung, Taiwan

    Ren Ching Wang

  4. Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan

    Chuan-Han Chen

  5. Biostatistics Task Force, Taichung Veterans General Hospital, Taichung, Taiwan

    Jun-Peng Chen

  6. Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

    Sheau-Fang Yang

  7. Department of Pathology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

    Sheau-Fang Yang

  8. Division of Hemato-Oncology, Department of Internal Medicine, Lioying Chi-Mei Hospital, Tainan, Taiwan

    Shang-Wen Chen

  9. Department of Pathology, Chi-Mei Medical Center, 901 Chung-Hwa Road, Yong-Kang District, Tainan, 71004, Taiwan

    Shih-Sung Chuang

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  1. Hsin-Ni Li
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Contributions

Hsin-Ni Li, conception, design, data acquisition, interpretation of results, drafting the article, and final approval; Ren Ching Wang, data acquisition and final approval; Chuan-Han Chen, data acquisition and final approval; Jun-Peng Chen, interpretation of results and final approval; Sheau-Fang Yang, data acquisition and final approval; Shang-Wen Chen, data acquisition and final approval; Shih-Sung Chuang, design, data acquisition, interpretation of results, revising the article and final approval.

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Correspondence to Shih-Sung Chuang.

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Li, HN., Wang, R.C., Chen, CH. et al. Distinctive patterns of marrow involvement by classic Hodgkin lymphoma are clues for diagnosis and subtyping. Virchows Arch 480, 899–907 (2022). https://doi.org/10.1007/s00428-022-03273-z

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  • DOI: https://doi.org/10.1007/s00428-022-03273-z

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