Hodgkin Lymphoma and Its Differential Diagnosis: New Twists on an Old Challenge

Abstract

Hodgkin lymphoma is a B-cell neoplasm that typically presents with localized, nodal disease. Tissues are characterized by few large neoplastic cells, usually comprising less than 10% of tissue cellularity, present in a background of abundant nonneoplastic inflammatory cells. This inflammatory microenvironment, although key to the pathogenesis, can make diagnosis a challenge because reactive conditions, lymphoproliferative diseases, and other lymphoid neoplasms may mimic Hodgkin lymphoma and vice versa. This review provides an overview of the classification of Hodgkin lymphoma, its differential diagnosis, including emerging and recently recognized entities, and strategies to resolve challenging dilemmas and avoid diagnostic pitfalls.

Keywords: Classic Hodgkin lymphoma; Differential diagnosis; EBV-positive mucocutaneous ulcer; Infectious mononucleosis; Mediastinal gray-zone lymphoma; Nodal T-follicular helper cell lymphoma; Nodular lymphocyte-predominant Hodgkin lymphoma; Primary mediastinal large B-cell lymphoma.