nodular sclerosis

Nodular sclerosis classic Hodgkin lymphoma (NSCHL) is defined histologically by broad bands of birefringent collagen fibrosis that divide the lymph node into nodules. Within these nodules, characteristic 'lacunar cells' are found—a variant of Reed-Sternberg cells that have abundant, pale cytoplasm which retracts during fixation, creating an empty space (lacuna) around the nucleus, distinguishing them from classic Reed-Sternberg cells (binucleate 'owl-eye' cells with prominent eosinophilic nucleoli, CD15+/CD30+). The nodular sclerosis subtype is the most common form of classic Hodgkin lymphoma (approximately 60-70% of cases) and has a notable predilection for young adults, particularly women, and frequently presents with a mediastinal mass, often found incidentally or associated with symptoms like cough or chest discomfort. Prognostically, it carries an intermediate prognosis among Hodgkin lymphoma subtypes. Unlike the mixed cellularity and lymphocyte-depleted subtypes, NSCHL does not have strong association with HIV or immunosuppression. Like other classic Hodgkin lymphomas, the neoplastic Reed-Sternberg/lacunar cells are of B-cell origin (despite lacking typical B-cell markers like CD20) and express CD15 and CD30. Staging follows the Ann Arbor system, and treatment typically involves ABVD chemotherapy with or without radiation depending on stage. Key differentiators from non-Hodgkin lymphoma include the presence of Reed-Sternberg/lacunar cells in a background of reactive inflammatory cells (lymphocytes, eosinophils, plasma cells, macrophages) within the fibrotic/nodular architecture.