The malignant cells in NSHL include lacunar ReedSternberg cells, large neoplastic cells with abundant cytoplasm and characteristic retraction artifact when fixed in formalin. Bands of collagenous fibrosis surround a proliferation of Reed-Sternberg and Hodgkin cells admixed with small lymphocytes, large transformed cells, eosinophils, plasma cells, and other inflammatory cells (Figure 71.1). Some of the neoplas-tic cells demonstrate a shrunken, hyperchromatic appearance that has been described as "mummified" cells. When sheets of Reed-Sternberg and Hodgkin cells are present, the term "syncytial variant NHSL" has been employed.

Several grading systems have been proposed for NHSL based upon the number of Reed-Sternberg/Hodgkin cells present. The most commonly used of these is the BNLI system, which divides cases into two grades.31 In grade 2 NSHL, sheets of Reed-Sternberg/Hodgkin cells are present in at least 25% of the nodules. Grade 1 cases, in contrast, contain fewer neoplastic cells. Although frequently used in research protocols, this grading scheme has not gained acceptance in routine clinical practice in the United States.

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