<prompt> Which type of Hodgkins disease is commonest in female and associated with excellent prognosis?Nodular sclerosisLymphocyte predominantLymphocyte depletedMixed cellularity  <response>: Ans. a Nodular sclerosis Ref. Robbins pathology 7thpg. 688Note-Classical is more common than lymphocyte predominanceCLASSIFICATION OF HODGKIN LYMPHOMASub typeMorphology and ImmunophenotypeTypical clinical featuresNodular sclerosisFrequent lacunar cells and occasional diagnosticR-S cells; background infiltrate composed of T lymphocytes, eosinophils, macrophages, and plasmacells; fibrous bands dividing cellular areas into nodules.Stage 1 or 2 disease most common.R-S cells CD15, CD30; EBV-.Frequent mediastinal involvement. FM, most patients young adultsMixed cellularityFrequent mononuclear and diagnostic R-S cells; background infiltrate rich in T lymphocytes, eosinophils, macrophages, plasma cells. R-S cells, CD15, CD30; 70 EBV More than 50 present as stage 3 or 4 disease. M F. Biphasic incidence, peaking in young adults and again in adults older than 55Lymphocyte-richFrequent mononuclear and diagnostic R-S cells; background infiltrate rich in T lymphocytes, R-S cells are CD15, CD30, 40 EBV.Uncommon. MF. Tends to be seenin older adultsLymphocyte depletionReticular variant: Frequent diagnostic R-S cells are variants with a paucity of background reactive cells; diffuse fibrosis variant; hypocellular fibrillar background with scattered diagnostic R-S cells and variants and few reactive cells.R-S cells CD15, CD30; most EBV.Uncommon. More common in older males, HIV infected individuals, and in developing countries.More likely to present with advanced disease.Lymphocyte predominanceFrequent L H popcorn cell variants in a background of follicular dendritic cells and reactive B cells. R-S cells CD20, CD15-, C30-; EBV-.Uncommon. Young males with cervical or axillary lymphadenopathy.MediastinalNodular Sclerosis Type equal frequency in males and females. It has a propensity to involve the lower cervical, supraclavicular, and mediastinal lymph nodes of adolescents or young adults and is only rarely associated with EBV. The prognosis is excellent.Mixed Cellularity Type Is more common in males. strongly associated with EBV older age, systemic symptoms such as night sweats and weight loss, and advanced tumor stage. Nonetheless, the prognosis is very good. FrequencySalient MorphologyImmunophenotypeCommentsPrecursor B-cell lymphoblastic leukemialymphoma85 of childhood acute leukemiaLymphoblasts with irregular nuclear contours, condensed chromatin, small nucleoli, and scant agranular cytoplasmTdTimmature B cells CD19, variable expression of other B-cell markersUsually presents as acute leukemia; less common in adults; prognosis is predicted by karyotypePrecursor T-cell leukemia lymphoma15 of childhood acute leukemia; 40 of childhood lymphomasIdentical to precursor B-cell lymphoblastic leukemialymphomaTdTimmature T cells CD2, CD7, variable expression of other T-cell markersMost common in adolescent males; often presents as a mediastinal mass due to thymic involvement; highly associated with mutations in NOTCH1Small lymphocytic lymphoma chronic lymphocytic leukemia3 to 4 of adult lymphomas; 30 of all leukemiasSmall resting lymphocytes mixed with variable numbers of large activated cells; lymph nodes diffusely effacedCD5B-cell expressing surface IgOccurs in older adults; usually involves nodes, marrow, and spleen; most patients have peripheral blood involvement; indolentFollicular lymphoma40 of adult lymphomasFrequent small cleaved cells mixed with large cells; growth pattern is usually nodular follicularCD10BCL2mature B cells that express surface IgOccurs in older adults; usually involves nodes, marrow, and spleen; associated with t14; 18; indolent Mantle cell lymphoma3 to 4 of adult lymphomasSmall to intermediate-sized irregular lymphocytes growing in a diffuse patternCD5mature B cells that express cyclin D1 and have surface IgOccurs mainly in older males; usually involves nodes, marrow, and spleen; GI tract also commonly affected; t11;14 is characteristic; moderately aggressiveExtranodal marginal zone lymphoma5 of adult lymphomasVariable cell size and differentiation; 40 show plasmacytic differentiation; B cells home to epithelium, creating Lymphoepithelial lesionsCD5- CD10- mature B cells with surface IgFrequently occurs at extranodal sites involved in chronic inflammation; very indolent; may be cured by local excisionDiffuse large B-cell lymphoma40 to 50 of adult lymphomasVariable; most resemble large germinal center B cells; diffuse growth patternMature B cells with variable expression of CD10 and surface IgOccurs in all ages, but most common in older adults; often arise at extranodal sites; aggressiveBurkitt lymphoma1 of lymphomas in the United StatesIntermediate-sized round lymphoid cells with several nucleoli; diffuse tissue involvement associated with apoptosis produces a starry-sky appearanceMature CD10B cells expressing surface IgEndemic in Africa, sporadic elsewhere; increased frequency in immunosuppressed patients; predominantly affects children; often presents with visceral involvement; highly aggressivePlasmacytoma plasma cell myelomaMost common lymphoid neoplasm in older adultsPlasma cells in sheets, sometimes with prominent nucleoli or inclusions containing IgTerminally differentiated plasma cells containing cytoplasmic IgMyeloma presents as a disseminated bone disease, often with destructive lytic lesions Hypercalcemia, renal insufficiency, and bacterial infections are commonMycosis fungoidesMost common cutaneous lymphoid malignancyIn most cases, small lymphoid cells with markedly convoluted nuclei; cells often infiltrate the epidermis Pautrier microabscessesCD4mature T cellsPresents with localized or more generalized skin involvement; generally indolent. Sezary syndrome, a more aggressive variant, is characterized by diffuse skin erythema and peripheral blood involvementPeripheral T-cell lymphoma, not otherwise specified NOSMost common adult T-cell lymphomaVariable; usually, a spectrum of small to large lymphoid cells with irregular nuclear contoursMature T-cell phenotype CD3Probably spans a diverse collection of rare tumors. Often disseminated, generally aggressiveHodgkin lymphoma, nodular sclerosis typeMost common type of Hodgkin lymphomaLacunar Reed-Sternberg cell variants in a mixed inflammatory background; broad sclerotic bands of collagen usually also presentCD15, CD30Reed- Sternberg cellsMost common in young adults, often arises in the mediastinum or cervical lymph nodesHodgkin lymphoma, a mixed cellularity typeSecond most common form of Hodgkin lymphomaFrequent classic Reed-Sternberg cells in a mixed inflammatory backgroundCD15, CD30Reed- Sternberg cellsMost common in men, more likely to present at advanced stages than the nodular sclerosis type EBVin 70 of cases 