title: Nodular sclerosis classical Hodgkin lymphoma grade 2: A diagnostic challenge to the cytopathologists.
abstract: BACKGROUND
  Grade 2 nodular sclerosis classical Hodgkin lymphoma (NSCHL) is less common than grade 1 lymphoma and has a worse overall prognosis. To the best of the authors' knowledge, no study of a large series of cases has been performed until now. The objective of this study was to assess the diagnostic efficacy of cytology for grade 2 NSCHL versus grade 1 NSCHL and study the morphological features of grade 2 NSCHL in fine-needle aspiration cytology (FNAC).
  
  
  METHODS
  Fifteen of 51 histopathology-proven cases of NSCHL (18 FNAC procedures) were grade 2, and 36 were grade 1. The efficacy of FNAC for detecting grade 1 and 2 NSCHL was assessed, and the frequency of misdiagnosis was compared. The clinical details and cytomorphological features of grade 2 NSCHL were studied in detail.
  
  
  RESULTS
  Among the grade 1 NSCHL patients, 58.4% were diagnosed with Hodgkin lymphoma (HL) or had findings suggestive of HL, whereas 20% of the grade 2 patients were diagnosed HL or suggestive of HL. Two cases of grade 2 NSCHL were misdiagnosed as anaplastic large cell lymphoma, and 4 were misdiagnosed as malignant neoplasms. Grade 2 NSCHL cases showed clusters and sheets of mononuclear, multinucleated, and bizarre cells, with some cases showing a suppurative background. However, extensive searching showed occasional Reed-Sternberg (RS) cells in most of the cases, and lacunar cells were seen in 12 cases.
  
  
  CONCLUSIONS
  The diagnostic efficacy of FNAC is much lower for grade 2 NSCHL versus grade 1 NSCHL. The search for an occasional RS cell and the identification of lacunar cells can provide a clue for the diagnosis. Cancer Cytopathol 2017;125:104-113. © 2016 American Cancer Society.
authors.affiliation: Department of Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Sudha
authors.initials: S
authors.lastname: Sharma
authors.affiliation: Department of Cytology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Pranab
authors.initials: P
authors.lastname: Dey
authors.affiliation: Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Suvradeep
authors.initials: S
authors.lastname: Mitra
authors.affiliation: Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Arvind
authors.initials: A
authors.lastname: Rajwanshi
authors.affiliation: Department of Cytology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Raje
authors.initials: R
authors.lastname: Nijhawan
authors.affiliation: Department of Cytology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Radhika
authors.initials: R
authors.lastname: Srinivasan
authors.affiliation: Department of Cytology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Nalini
authors.initials: N
authors.lastname: Gupta
authors.affiliation: Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Ashim
authors.initials: A
authors.lastname: Das
mesh_terms: D000293:Adolescent; D000328:Adult; D044963:Biopsy, Fine-Needle; D002648:Child; D002675:Child, Preschool; D003581:Cytodiagnosis; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D005260:Female; D006689:Hodgkin Disease / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011379:Prognosis
keywords: Hodgkin lymphoma; fine-needle aspiration cytology; nodular sclerosis classical Hodgkin lymphoma