Which disease is diagnosed by the presence of Reed‑Sternberg cells?

Reed-Sternberg Cells are Diagnostic for Hodgkin Lymphoma

Reed-Sternberg cells are the defining pathologic feature essential for the diagnosis of classical Hodgkin lymphoma (cHL), representing the malignant cell population that distinguishes this disease from non-Hodgkin lymphomas. 1

Diagnostic Significance

• The presence of Reed-Sternberg cells (also called Hodgkin-Sternberg cells) is required for diagnosis of classical Hodgkin lymphoma, which accounts for 95% of all Hodgkin lymphoma cases 2, 1

• These malignant cells are peculiar in that they represent only 0.1-1% of the entire cell population within affected lymph nodes, embedded within a heterogeneous inflammatory background of lymphocytes, histiocytes, eosinophils, plasma cells, and fibroblasts 2

• A lymph node biopsy is always required for diagnosis of Hodgkin lymphoma, as fine-needle aspiration is insufficient to identify Reed-Sternberg cells and assess the characteristic architectural patterns 2, 1

Immunophenotypic Characteristics

The Reed-Sternberg cells in classical Hodgkin lymphoma have a distinctive immunophenotype that aids in diagnosis:

• CD15+/CD30+/CD20- is the characteristic pattern for classical HL 2
• This contrasts with lymphocyte-predominant Hodgkin lymphoma (5% of cases), where the malignant "popcorn cells" are CD15-/CD30-/CD20+ 2, 1

Important Diagnostic Pitfall

Reed-Sternberg-like cells can occasionally appear in non-Hodgkin lymphomas (both B-cell and T-cell types), creating a significant diagnostic challenge. 3, 4

• In non-Hodgkin lymphomas, these Reed-Sternberg-like cells are typically scattered or in small clusters, lacking the characteristic inflammatory background microenvironment of classical Hodgkin lymphoma 3, 4

• Immunohistochemical detection of a panel of markers is mandatory to distinguish classical Hodgkin lymphoma from non-Hodgkin lymphomas with Reed-Sternberg-like cells, as treatment protocols and prognosis differ significantly 3, 4

• A monomorphic background population with CD20 positivity should raise suspicion for B-cell non-Hodgkin lymphoma rather than classical Hodgkin lymphoma 3

Clinical Context

• Hodgkin lymphoma has a bimodal age distribution with peaks at 15-30 years and after age 55 years 1
• With modern treatment, Hodgkin lymphoma is now curable in at least 80% of patients 1
• Most patients (>60%) initially present with enlarged cervical lymph nodes 2