What is 'Lacunar type' of Reed-Sternberg (RS) cells are seen in which type of Hodgkin's lymphoma? and explain in detail?
Ans a (Nodular Sclerosis) (Ref. Robbin's Pathology 8th/Table 12-8.; 7th/table 14-6)SubtypeMorphotogy and ImmunophenotypeTypical Clinical FeaturesNoduiar selerosisFrequent lacunar cells and occasional diagnostic R-S cells: background infiltrate composed of T lymphocytes, eosinophils, macrophages and plasma cells, fibrous bands dividing cellular areas into nodules. R-S cells CD15+, CD30+, EBV.Stage 1 or 2 disease most common. Ferquent mediastinal involvement F = M, most patients young adultsMixed cellularityFrequent mononuclear and diagnostic R-S cells; background infiltrate 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 55.Lymphocyte-richFrequent mononuclear and diagnostic R-S cells; background infiltrate rivh in T lymphocytes. R-C cells. CD15+, CD30+; 40% EBV+.Uncommon. M>F. Tends to be seen in older adults.Lymphocyte depletionReticular variant: Frequent diagnostic R-S cells and variants with a paucity of background reactive cells; diffuse fibrosis variant; hypocellular fibrillary 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.Lymphocytes predominanceFrequent 1 & II (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. Mediastinal.SUMMARY OF THE MORE COMMON LYMPHOID NEOPLASMSEntityFrequencySalient MorphologyImmunophenotypeCommentsPrecursor B-cell lym- phoblastic leukemia/ lymphoma85% of childhood acute leukemiaLymphoblasts with irre- gular nuclear contours, condensed chromatin, small nucleoli, and scant agranular cytoplasmTdT+immature B cells (CD19+, variable expression of other B-cell markers)Usually presents as acute leukemia; less common in adults; prognosis is predicted by karyotypePrecursor T-cell leukemia/ lymphoma15% of childhood acute leukemia; 40% of child- hood lymphomasIdentical to precursor B-cell lymphoblastic leukemia/lymphomaTdT+immature T cells (CD2+, CD7+, variable expression of other T-cell markers)Most common in adolescent males; often presents as a mediastinal mass due to thymic involvement; asso with NOTCH1 mutationSmall lymphocytic lymphoma/chronic lymphocytic leukemia3% to 4% of adult lymphomas; 30% of all leukemiasSmall resting lymphocytes mixed with variable numbers oflarge activated cells; lymph nodes diffusely effacedCD5+B-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 (follicular)CD10+BCL2+mature B cells that express surface IgOccurs in older adults; usually involves nodes, marrow, and spleen; associated with t(14;18); indolentMantle cell lymphoma3% to 4% of adult lymphomasSmall to intermediate- sized irregular lymphocytes growing in a diffuse patternCD5+mature 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; t(11;14) is characteristic; moderately aggressiveExtranodal marginal zone lymphoma<5% of adult lymphomasVariable cell size and differentiation; 40% show plasmacytic differentiation; B cells home to epithelium, creating "lymphoepithelial lesions"CD5- CD10- mature B cells with surface IgFrequently occurs at extranodal sites involved by 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 lymphoma<1% of lymphomas in the United StatesIntermediate-sized round lymphoid cells with several nucleoli; diffuse tissue involvement associated with apoptosis produces a "starry-sky" appearanceMature CD10+B 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 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 microabscesses)CD4+mature 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 (NOS)Most common adult T-cell lymphomaVariable; usually a spectrum of small to large lymphoid cells with irregular nuclear contoursMature T-cell phenotype (CD3+)Probably spans a diverse collection of rare tumors. Often disseminated, generally aggressive