Lymphoma Pathology Study Guide

Lymphadenopathy (LAD)

Large lymph nodes are referred to as lymphadenopathy (LAD).

Typically, lymph nodes that are draining an area of acute infection show painful lymphadenopathy (acute lymphadenitis).

Causes of lymphadenopathy include:

Benign lymph node hyperplasia
Reactive lymph node
Acute inflammation (acute lymphadenitis)
Metastatic cancer
Chronic inflammation (chronic lymphadenitis)
Lymphoma

Hyperplasia of specific lymph node areas causes lymph node hypertrophy during inflammation.

For instance, early phases of infection and rheumatoid arthritis both exhibit follicular hyperplasia in the B-cell area of lymph nodes.

With viral infections, paracortical hyperplasia (in the T-cell area) is observed (e.g., infectious mononucleosis).

In lymph nodes that drain cancerous tissue, sinus histiocyte hyperplasia might be observed.

Lymphadenopathy. Ultrasonography of a suspected malignant lymph node: - Absence of the fatty hilum - Increased focal cortical thickness greater than 3 cm - Doppler ultrasonography that shows hyperaemic blood flow in the hilum and central cortex and/or abnormal (non-hilar cortical) blood flow.[26] Vandana Dialani, D F James, Priscilla Slanetz . Not altered. CC BY 4.0
Lymphadenopathy. Retroperitoneal lymphadenopathies of testicular seminoma embrace the aorta. Computed tomography image. Jmarchn - Not altered CC BY-SA 3.0

Lymphoma

Lymphomas are the malignant proliferation of hematopoietic cells involving a lymph node or extranodal tissue.

Lymphomas are generally categorized as:

Hodgkin lymphoma (HL, 40%)
Non-Hodgkin lymphoma (NHL, 60%)

Non-Hodgkin lymphoma (NHL) is further divided into subtypes based on the expression of surface markers, cell size, pattern of cell proliferation, cell type, and cytogenetic translocations.

Non-Hodgkin lymphomas (NHLs) are broadly categorized into two groups:

Natural killer/T-cell lymphomas
B-cell lymphomas

Natural killer/T-cell lymphomas account for approximately 15% of non-Hodgkin lymphomas.

B-cell lymphomas account for approximately 85% of non-Hodgkin lymphomas.

Non-Hodgkin B cell lymphomas include:

Acute lymphoblastic lymphoma
Follicular lymphoma
Mantle cell lymphoma
Marginal zone lymphoma
Diffuse large B cell lymphoma
Burkitt lymphoma
Chronic lymphocytic leukemia/Small lymphocytic lymphoma (CLL/SLL)

The more commonly tested entities are further discussed below.

Burkitt Lymphoma. Burkitt lymphoma, touch prep, Wright stain. Ed Uthman, MD. Not altered. CC BY 2.0
Lymphoma Pathology. CT scan of axillary lymphadenopathy in a 57 year old man with multiple myeloma. Mikael Häggström. Not altered. CC0
Mantle Cell Lymphoma. Micrograph of terminal ileum with mantle cell lymphoma (bottom of image). H&E stain. Nephron - Not altered. CC BY-SA 3.0
Extranodal sites involved in non-Hodgkin lymphoma. Waldeyer's ring includes tonsil, palate, nasopharynx, pharynx and base of tongue; GI tract (gastrointestinal tract) includes stomach, small intestine and colon; Nose & sinuses includes nasal cavity and paranasal sinuses; CNS, central nervous system. Subtype distribution of lymphomas in Southwest China: analysis of 6,382 cases using WHO classification in a single institution. Yang QP, Zhang WY, Yu JB, Zhao S, Xu H, Wang WY, Bi CF, Zuo Z, Wang XQ, Huang J, Dai L, Liu WP - Diagnostic pathology (2011). Not altered. CC.
Histology of a patient with Retinal lymphoma. Patient had decreased vision in the right eye. The region of retinal thickening is hypercellular and hyperchromatic (too blue). Retinal lymphoma, large B-cell type Nickens CMN - MedPix Images (2012). Not Altered. CC.
Splenic Marginal Zone Lymphoma. Morphology of Splenic marginal zone lymphoma. Characteristic micronodular pattern in the SMZL centered in the white pulp, with variable red pulp infiltration (H&E, original magnification ×100). Coexistence of splenic marginal zone lymphoma with hepatocellular carcinoma: a case report. Zhang SH, Xu AM, Zheng JM, He MX - Diagnostic pathology (2007). Not altered. CC.
Mantle Cell Lymphoma FISH. FISH image of MCL showing the CCND1 gene disruption (FISH, ×1,000); red/green signals marked the two ends of the CCND1 gene. A positive pattern showed two separate red and green signals. FISH, fluorescence in situ hybridization; MCL, mantle cell lymphoma. Clinicopathologic features of 112 cases with mantle cell lymphoma. Zhou DM, Chen G, Zheng XW, Zhu WF, Chen BZ - Cancer biology & medicine (2015). Not altered. CC.
Diffuse Large B-Cell Lymphoma. Morphologic features of DLBCL (hematoxylin and eosin, 440x). Prognostic Significance of Bcl-2 and p53 Protein Expressions and Ki67 Proliferative Index in Diffuse Large B-cell Lymphoma. Küçükzeybek BB, Bener S, Çallı AO, Paksoy TD, Payzin B - Turkish journal of haematology : official journal of Turkish Society of Haematology (2013). Not altered. CC.

Mantle Cell Lymphoma

Mantle cell lymphoma consists of small B cell (CD20+) neoplastic growth that increases the mantle zone.

Mantle cell lymphoma clinically presents with lymphadenopathy without pain that first appears in late adulthood.

Mantle cell lymphoma is driven by t(11;14).

On chromosome 11, the Cyclin D gene moves to the Ig heavy chain locus.

Cyclin D1 over-expression encourages the Gl/S transition in the cell cycle, aiding the growth of cancerous cells.

Mantle Cell Lymphoma. Micrograph of terminal ileum with mantle cell lymphoma (bottom of image). H&E stain. Nephron - Not altered. CC BY-SA 3.0
Mantle Cell Lymphoma. Micrograph of terminal ileum with mantle cell lymphoma (bottom of image - brown color). Cyclin D1 immunostain. Nephron -Not altered. CC BY-SA 3.0
Mantle Cell Lymphoma. Mantle cell lymphoma. Notice the irregular nuclear contours of the medium-sized lymphoma cells and the presence of a pink histiocyte. By immunohistochemistry the lymphoma cells expressed CD20, CD5 and Cyclin D1 (high power view, H&E) Gabriel Caponetti - Not altered. CC BY-SA 3.0
Mantle Cell Lymphoma. Lymph node with mantle cell lymphoma (low power view, H&E) Gabriel Caponetti - Not altered. CC BY-SA 3.0
Mantle Cell Lymphoma. Intermediate magnification micrograph of mantle cell lymphoma of the terminal ileum. Endoscopic biopsy. H&E stain. Histomorphologic features: Monomorphic small lymphoid cells less than twice the size of a resting lymphocyte. Abundant mitoses. Sclerosed blood vessels. Scattered epithelioid histiocytes. Immunohistochemical staining: Positive: Cyclin D1, CD5, CD43, CD20, CD45. Negative: CD23. Molecular features: t(11;14)(q13;q32). CCND1/IGHG1 fusion gene.[1] E Related images Low mag. Intermed. mag. Low mag. - cyclin D1. Intermed. mag. - cyclin D1. References URL: https://www.ncbi.nlm.nih.gov/omim/168461. Accessed on: 18 August 2010. Nephron - Not altered. CC BY-SA 3.0
Mantle Cell Lymphoma FISH. FISH image of MCL showing the CCND1 gene disruption (FISH, ×1,000); red/green signals marked the two ends of the CCND1 gene. A positive pattern showed two separate red and green signals. FISH, fluorescence in situ hybridization; MCL, mantle cell lymphoma. Clinicopathologic features of 112 cases with mantle cell lymphoma. Zhou DM, Chen G, Zheng XW, Zhu WF, Chen BZ - Cancer biology & medicine (2015). Not altered. CC.
Mantle zone lymphoma. (A) The germinal center was surrounded by a thickened lymphocyte sleeve (H&E, ×200); (B) Immunohistochemistry: cyclin D1 (+) (Envision, ×400); (C) Ki-67 expression was low (Envision, ×400). Clinicopathologic features of 112 cases with mantle cell lymphoma. Zhou DM, Chen G, Zheng XW, Zhu WF, Chen BZ - Cancer biology & medicine (2015).

Marginal Zone Lymphoma

Marginal zone lymphoma consists of small neoplastic B-cells that are CD20+ are proliferating which expands the marginal zone.

Marginal zone lymphoma is associated with long-term inflammatory conditions such as:

Helicobacter pylori gastritis
Sjogren syndrome
Hashimoto thyroiditis

B-cells from the post-germinal center form the marginal zone.

Mucosa associated lymphoid tissue (MALT) lymphoma is a mucosal-site marginal zone lymphoma.

Treatment for H Pylori may cause the gastric MALT lymphoma to regress.

Marginal Zone Lymphoma. Micrograph of kidney with lymphoma (marginal zone B-cell lymphoma). H&E stain. Librepath. Not altered. CC BY-SA 3.0
Splenic marginal zone B-cell lymphoma, nodular and diffuse pattern of infiltration. a H&E (×10); b CD20 (×10); c TCL1A results negative in the neoplastic cells (×10); d MNDA results positive in the neoplastic component (×10). Absence of TCL1A expression is a useful diagnostic feature in splenic marginal zone lymphoma. Munari E, Rinaldi M, Ambrosetti A, Bonifacio M, Bonalumi A, Chilosi M, Zamò A - Virchows Archiv : an international journal of pathology (2012). Not altered.
Splenic Marginal Zone Lymphoma. Morphology of Splenic marginal zone lymphoma. Characteristic micronodular pattern in the SMZL centered in the white pulp, with variable red pulp infiltration (H&E, original magnification ×100). Coexistence of splenic marginal zone lymphoma with hepatocellular carcinoma: a case report. Zhang SH, Xu AM, Zheng JM, He MX - Diagnostic pathology (2007). Not altered. CC.
Nodal marginal zone lymphoma. At low magnification, nodular growth pattern with pale cell can be seen (HE staining). Ding-Bao Chen. Nodal marginal zone lymphoma (NMZL). Atlas Genet Cytogenet Oncol Haematol. 2019;23(2):41-45. Not altered.
Extranodal Marginal Zone Lymphoma. a Pathological findings revealed tumor cells that were located in alveolar interseptal spaces. The alveolar walls remained intact. b Tumor cells showed slight atypia with hyperchromatic nuclei. Lymphoepithelial lesions were observed in the specimen. c Tumor cells were positive for CD20 expression. d Tumor cells were positive for BCL2 expression. Primary extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue with multiple pure ground-glass opacities: a case report. Journal of Cardiothoracic Surgery. Not altered. CC.
Extranodal Marginal Zone Lymphoma. (a) Microscopic finding shows the extranodal marginal zone lymphoma of MALT in a background of Hashimoto's thyroiditis (H&E stain, ×20). (b) Microscopic finding of the thyroid mass shows marked lymphocytic infiltration and a few degenerated follicles (H&E stain, ×200). (c) Immunohistochemical findings disclose diffuse positive staining for CD20 (immunohistochemistry, ×200). (d) Immunostaining for cytokeratin highlights lymphoepithelial lesions (immunohistochemistry, ×200). Primary Mucosa-Associated Lymphoid Tissue Lymphoma of Thyroid with the Serial Ultrasound Findings. Jeon EJ, Shon HS, Jung ED - Case reports in endocrinology (2016). Not altered. CC.
Marginal Zone Lymphoma. Morphology of Splenic marginal zone lymphoma. Characteristic micronodular pattern in the SMZL centered in the white pulp, with variable red pulp infiltration (H&E, original magnification ×100). Coexistence of splenic marginal zone lymphoma with hepatocellular carcinoma: a case report. Zhang SH, Xu AM, Zheng JM, He MX - Diagnostic pathology (2007).
Splenic bleeding of splenic marginal zone lymphoma (SMZL). (A) A dynamic CT scan of the abdomen on admission. (B) Histology of the excised spleen. Hematoxylin and Eosin (H&E) staining. Magnification, ×100, inset×1,000. (C) Histology of the excised lymph node. H&E staining. Magnification, ×20. Inset, ×400. (D) PCR amplification of complementarity determining region-3 (CDR-3). The spleen (Sp) and lymph node (LN) lanes show monoclonal bands of the same size. VH26, forward primer. VLJH, reverse primer for second PCR. JH, reverse primer for first PCR. M, size marker. Neg, negative control. Pos, positive control. Splenic Marginal Zone Lymphoma with Acquired von Willebrand Syndrome Diagnosed via Splenic Bleeding, Internal Medicine.
Marginal Zone Lymphoma. Splenic marginal zone B-cell lymphoma, nodular and diffuse pattern of infiltration. a H&E (×10); b CD20 (×10); c TCL1A results negative in the neoplastic cells (×10); d MNDA results positive in the neoplastic component (×10). Absence of TCL1A expression is a useful diagnostic feature in splenic marginal zone lymphoma. Munari E, Rinaldi M, Ambrosetti A, Bonifacio M, Bonalumi A, Chilosi M, Zamò A - Virchows Archiv : an international journal of pathology (2012). Not altered. CC.

Burkitt Lymphoma

Burkitt lymphoma is due to the neoplastic proliferation of intermediate-sized cells (CD20+).

Burkitt lymphoma is associated with Epstein Barr virus (EBV).

Common clinical features of Burkitt lymphoma include:

Typically manifests in children or young adults
Typically presents as an extranodal mass
Patient is typically of African decent
The jaw is typically involved
The abdomen is typically involved

Burkitt lymphoma is driven by c-MYC translocations (chromosome 8).

The most frequent mutation in Burkitt lymphoma is t(8;14)

Translocation 8;14 causes c-MYC to be translocated to the lg heavy chain gene on chromosome 14.

C-MYC oncogene over-expression encourages cell proliferation.

Burkitt lymphoma classically has a high mitotic count and a “starry-sky” histologic appearance due to abundant tingible body macrophages.

Burkitt Lymphoma. Burkitt lymphoma, touch prep, Wright stain. Ed Uthman, MD. Not altered. CC BY 2.0
Burkitt Lymphoma. Seven-year-old Nigerian boy with a several-month history of jaw swelling which had been treated with antibiotics: The tumor was ulcerated and draining. Mike Blyth - Not altered. CC BY-SA 2.5
Burkitt Lymphoma. Starry Night over the Rhone. Van Gogh. 1888. Analogies in medicine: starry-sky appearance. Andrade-Filho Jde S - Revista do Instituto de Medicina Tropical de São Paulo (2014 Nov-Dec). Not altered. CC.
Burkitt Lymphoma. Dr. Denis Burkitt, a child with Burkitt lymphoma and the“starry-sky pattern”. Analogies in medicine: starry-sky appearance. Andrade-Filho Jde S - Revista do Instituto de Medicina Tropical de São Paulo (2014 Nov-Dec). Not altered. CC.
Burkitt Lymphoma. The macroscopic photograph of Burkitt lymphoma. (a) A 12-years boy presented with abdominal lesions. There was a huge mass within the mesentery and multiple polyploid lesions were present in the cecum; (b) a 6-years boy had a jejunum mass, with thickening of intestinal wall and hemorrhage; (c) an 8-years boy presented with a big facial bone mass. Sporadic Burkitt lymphomas of children and adolescents in Chinese: a clinicopathological study of 43 cases. Bi CF, Tang Y, Zhang WY, Zhao S, Wang XQ, Yang QP, Li GD, Liu WP - Diagnostic pathology (2012). Not altered. CC.
Burkitt Lymphoma. In situ hybridization for EBER in Burkitt’s lymphoma. Note diffuse and strong staining showing early RNA transcripts of EBV accumulated in the nucleus of EBV-infected cells (Ventana® EBER ISH iView Blue Plus Kit; original magnification x200). The role of EBV in the pathogenesis of Burkitt's Lymphoma: an Italian hospital based survey. Pannone G, Zamparese R, Pace M, Pedicillo MC, Cagiano S, Somma P, Errico ME, Donofrio V, Franco R, De Chiara A, Aquino G, Bucci P, Bucci E, Santoro A, Bufo P - Infectious agents and cancer (2014). Not altered. CC.
Burkitt Lymphoma. Immunohistochemical expression of LMP-1 in Burkitt’s lymphoma. Note the strong nuclear staining of EBV-infected cells. (LSAB-HRP, x400; nuclear counterstaining with type II Gill’s Haematoxylin). The role of EBV in the pathogenesis of Burkitt's Lymphoma: an Italian hospital based survey. Pannone G, Zamparese R, Pace M, Pedicillo MC, Cagiano S, Somma P, Errico ME, Donofrio V, Franco R, De Chiara A, Aquino G, Bucci P, Bucci E, Santoro A, Bufo P - Infectious agents and cancer (2014). Not altered. CC.
Burkitt Lymphoma. Burkitt’s lymphoma of the child - Histopathology and immunohistochemistry. a, Medium sized lymphocytes with high mitotic index and macrophages with tingible bodies (Hematoxylin-Eosin, 60x); b, CD79a expression; c, bcl6 expression; d, CD 20 expression; e, CD 10 expression; f, Ki 67 expression (LSAB-HRP, nuclear counterstaining with type II Gill’s Haematoxylin). The role of EBV in the pathogenesis of Burkitt's Lymphoma: an Italian hospital based survey. Pannone G, Zamparese R, Pace M, Pedicillo MC, Cagiano S, Somma P, Errico ME, Donofrio V, Franco R, De Chiara A, Aquino G, Bucci P, Bucci E, Santoro A, Bufo P - Infectious agents and cancer (2014). Not altered. CC.
Burkitt Lymphoma. Burkitt’s lymphoma of the adult - Histopathology and immunohistochemistry. a, Medium sized lymphocytes with high mitotic index and macrophages with tingible bodies (Hematoxylin-Eosin, 40x); b, CD79a expression; c, bcl6 expression; d, CD 20 expression; e, CD 10 expression; f, Ki- 67 expression (LSAB-HRP, nuclear counterstaining with type II Gill’s Hematoxylin). The role of EBV in the pathogenesis of Burkitt's Lymphoma: an Italian hospital based survey. Pannone G, Zamparese R, Pace M, Pedicillo MC, Cagiano S, Somma P, Errico ME, Donofrio V, Franco R, De Chiara A, Aquino G, Bucci P, Bucci E, Santoro A, Bufo P - Infectious agents and cancer (2014). Not altered. CC.
Burkitt Lymphoma. Biopsy of preaortic lymph node showing monomorphic moulded neoplastic lymphoid cells with large pale macrophage "stars". Burkitt lymphoma masquerading as cardiac tamponade. Kaul P, Javangula K - Journal of cardiothoracic surgery (2007). Not altered. CC.

Diffuse Large B-Cell Lymphoma (DLBCL)

Large B cells (CD20+) that proliferate neoplastically and spread out in sheets.

Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma (NHL).

DLBCL may be due to spontaneous mutations or result from a low-grade lymphoma transforming into DLBCL (e.g. follicular lymphoma transforming into DLBCL).

DLBCL typically presents as an extranodal tumor or an expanding lymph node in late adulthood.

Diffuse Large B-Cell Lymphoma. Micrograph of a diffuse large B cell lymphoma, abbreviated DLBCL. Lymph node FNA specimen. Field stain. Nephron. Not altered. CC BY-SA 3.0
Diffuse Large B-Cell Lymphoma. Morphologic features of DLBCL (hematoxylin and eosin, 440x). Prognostic Significance of Bcl-2 and p53 Protein Expressions and Ki67 Proliferative Index in Diffuse Large B-cell Lymphoma. Küçükzeybek BB, Bener S, Çallı AO, Paksoy TD, Payzin B - Turkish journal of haematology : official journal of Turkish Society of Haematology (2013). Not altered. CC.
Diffuse Large B-Cell Lymphoma. (A) Hematoxylin and eosin (H&E)–stained image showing diffuse large B-cell lymphoma of the right breast. (B) Immunohistochemical staining with positivity for CD20. (C) Gross specimen of the right testis, epididymis, and spermatic cord with an ovoid mass (3.8×2.5×1.6 cm). (D) H&E-stained image consistent with diffuse large B-cell lymphoma of the testis. Diffuse Large B-Cell Lymphoma with Involvement of the Breast and Testis in a Male Patient. Choi E, Jo JC, Yoon DH, Kim S, Lee K, Huh J, Park CS, Lee SW, Suh C - Cancer research and treatment : official journal of Korean Cancer Association (2014). Not altered. CC.
Diffuse Large B-Cell Lymphoma (DLBCL) case showing centroblastic morphology in hematoxylin and eosin (A).The phenotypic profile shows extensive nuclear positivity for MYC (B), FOXP1 (C) and KI-67, with high proliferation fraction (D). Immunoblastic variant of DLBCL (E–H). The majority of cells show prominent central nucleoli in hematoxylin and eosin (E). The phenotypic profile shows extensive positivity for MYC (F) and BCL2 (G) staining. (H) Low magnification of tissue microarray core illustrating the MYC expression. Double-Hit BCL6/MYC DLBCL (I–K). Proliferation of intermediate monotonous population of intermediate-sized to large-sized lymphoid cells (I). FISH for BCL6 (J) and MYC (K) shows translocation of these genes with 1 normal fusion signal and a split signal. Immunohistochemical and molecular characteristics with prognostic significance in diffuse large B-cell lymphoma. Bellas C, García D, Vicente Y, Kilany L, Abraira V, Navarro B, Provencio M, Martín P - PloS one (2014). Not altered. CC.

Hodgkin Lymphoma (HL)

Hodgkin lymphoma is characterized by Reed-Sternberg (RS) cells.

Reed-Sternberg (RS) cells are giant B cells with multilobed nuclei and noticeable nucleoli (or “owl-eyed nuclei”).

Cytokines are released by Reed-Sternberg cells which recruit lymphocytes, plasma cells, macrophages, and eosinophils to the area that surround the Reed Sternberg cells.

The majority of the tumor is made up of inflammatory cells that are reactive, which is how Hodgkin lymphoma (HL) is categorized.

Subtypes of Hodgkin lymphoma (HL) include:

Classic (normal expected immune cells surrounding Reed Sternberg cells)
Nodular sclerosing (has bands of fibrosis cross lymphoid tissue)
Lymphocyte-rich (has lots of lymphocytes) – best prognosis
Lymphocyte-depleted (has few lymphocytes) – worst prognosis

Symptoms of Hodgkin lymphoma (HL) classically include the “B” symptoms:

Fever
Chills
Night sweats

Young adults, mostly females, get Hodgkin lymphoma (HL).

Patients with Hodgkin lymphoma (HL) typically present with enlarged cervical or mediastinal lymph nodes.

Hodgkin lymphoma (HL) is positive for CD15, CD30, PAX5, MUM1, and Fascin.

Hodgkin lymphoma (HL) is negative for CD20, and CD45.

Hodgkin Lymphoma. Micrograph of a classic Reed–Sternberg cell Unknown author - National Cancer Institute, AV Number: CDR576466 Not altered. Public Domain
Hodgkin Lymphoma. Micrograph showing a "popcorn cell", the Reed–Sternberg cell variant seen in nodular lymphocyte predominant Hodgkin lymphoma. H&E stain Nephron - Not altered. CC BY-SA 3.0
Hodgkin Lymphoma. CT image of a 46-year-old person with Hodgkin lymphoma, image at neck height. On the left side of the person's neck enlarged lymph nodes are visible (marked in red). JHeuser - JHeuser Not altered. CC BY-SA 3.0
Hodgkin Lymphoma. Lymph node biopsy showing Hodgkin lymphoma, mixed-cellularity type Not altered CC BY-SA 3.0
Lymphoma. Hodgkin lymphoma, nodular lymphocyte predominant (high-power view): Notice the presence of L&H cells, also known as "popcorn cells". (H&E) Gabriel Caponetti - Not altered. CC BY-SA 3.0
Hodgkin Lymphoma. Micrograph of Hodgkin lymphoma, abbreviated HL. Lymph node FNA specimen. Field stain. The micrograph shows a mixture of cells common in HL: Eosinophils. Reed-Sternberg cells. Plasma cells. Histocytes. Related images Small. Large. Nephron. Not altered. CC BY-SA 3.0
A) Lung Hodgkin lymphoma, large atypical Reed Sternberg like cells in background of inflammatory cells infiltration surrounded by fibrous septa on ×200 magnification. B) Lung Hodgkin Lymphoma, diagnostic binuclear Reed Sternberg cells with eosinophillic inclusions like nucleoli on ×400 magnification. C) Hodgkin lymphoma, immunohistochemical analysis showing clusters of Reed Sternberg cell react (cells react) with CD15 on ×400 magnification. D) Hodgkin lymphoma, immunohistochemical analysis showing clusters of Reed Sternberg cell reacts (cells react) with CD30 on ×400 magnification. Primary Pulmonary Hodgkin Lymphoma. Tanveer S, El Damati A, El Baz A, Alsayyah A, ElSharkawy T, Regal M - Rare tumors (2015). Not Altered. CC.