Hodgkin's Disease, Body-Cavity-Based Lymphoma,

Intravascular Lymphoma

Hodgkin's disease

Hodgkin's disease in the lung is usually secondary to disease elsewhere. It is characterized by the presence of Reed-Sternberg cells (CD15 and CD30-positive) and a mixed, reactive, inflammatory infiltrate of PMNs, eosinophils, and lymphoid cells.

Here, two large, binucleated cells (arrows) are mixed with scattered PMNs and lymphoid cells.

Reed-Sternberg cell

R-S cells have bilobed or double nuclei with prominent nucleoli (arrow). Other types of malignant cells can mimic R-S cells, and thus, the reaction of these cells with CD15 and CD30 is helpful in confirming a diagnosis of Hodgkin's disease. Note the PMNs. Other cells with small nuclei are lymphocytes and plasma cells.

Body-cavity-based lymphoma--pleural space

This lymphoma presents as a pleural effusion. Atypical lymphoid cells are larger than normal lymphocytes and have clumped, dark nuclear chromatin. Clonality for B cells can be demonstrated.

This lymphoma is a Kaposi sarcoma herpesvirus (human herpesvirus-8)-related disease.

Compare the size of the eosinophil and PMN (arrows) to that of the tumor cells.

Intravascular lymphoma

Rarely, large cell lymphomas, usually B-cell type, remain confined to blood vessels. They present with neurologic symptoms or dyspnea. This vessel shows many cells with large, pale, irregular nuclei. A few lymphocytes are also present (arrow).

Intravascular lymphoma--B-cell stain

The neoplastic cells (CD20-positive) plug capillaries. This vascular obstruction produces the dyspnea.