MacLennan et al described two histologic grades of nodular sclerosing Hodgkin's disease. These correlate with prognosis, with Grade 1 low grade and Grade 2 high grade. The authors are from the British National Lymphoma Investigation (BNLI).
Criteria for nodular sclerosing Hodgkin's disease:
(1) nodular pattern
(2) lacunar cells present
(3) minimal or greater degree of intranodal, birefrigent collagen band formation
Grades:
(1) Grade 1 = anything not Grade 2, including borderline cases
(2) Grade 2 = large areas of lymphocyte depletion or pleomorphic cytology
Patterns in Grade 2
Percent Required
reticular lymphocyte depleted
> 25%
pleomorphic lymphocyte depleted
> 25%
fibrohistiocytic lymphocyte depleted
> 75%
mixed cellularity and pleomorphic
> 25%
Lacunar and Reed Sternberg Cells
Lymphocytes
Other
Pattern
partial or complete replacement of the cellular nodules
depleted
NA
reticular lymphocyte depleted
highly cellular proliferation, appearing bizarre and anaplastic
depleted
NA
pleomorphic lymphocyte depleted
scanty
depleted
fibrohistiocytic proliferation
fibrohistiocytic lymphocyte depleted
large numbers of highly pleomorphic and malignant appearing
not depleted
NA
mixed cellularity and pleomorphic
where:
• The Reed Sternberg cell proliferation in Grade 2 (all but the fibrohistiocytic pattern) may appear as a sheet of cells filling a 40 times objective lens.
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