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Updated: May 25, 2026
Multiplexed Fluorescent Immunohistochemical Staining, Imaging, and Analysis in Histological Samples of Lymphoma
Published on: January 9, 2019
Use of an expanded immunohistochemical panel to distinguish cutaneous Hodgkin lymphoma from histopathologic imitators
Raymond J Cho1, Timothy H McCalmont, Weiyun Z Ai
1Department of Dermatology, University of California-San Francisco, 1701 Divisadero St., San Francisco, CA 94115, USA.
Insights
Classical Hodgkin lymphoma, a B-cell malignancy, can present in the skin. This study identifies key B-cell markers (PAX5, Oct-2, BOB.1) to help diagnose cutaneous Hodgkin lymphoma.
Area of Science:
- Oncology
- Immunohistochemistry
- Dermatopathology
Background:
- Classical Hodgkin lymphoma (cHL) diagnosis relies on specific cell markers, but differentiation from non-Hodgkin lymphoma (NHL) can be challenging.
- Cutaneous involvement by cHL requires distinguishing it from other skin lymphomas like anaplastic large cell lymphoma (ALCL), diffuse large B-cell lymphoma (DLBCL), and mycosis fungoides.
- Recent research indicates cHL originates from B-cells, expressing B-cell markers like PAX5, Oct-2, and BOB.1, which are typically absent in T-cell lymphomas.
Observation:
- A 40-year-old male patient presented with classical Hodgkin lymphoma and subsequent cutaneous nodules.
- A biopsy of a skin nodule revealed Hodgkin/Reed-Sternberg cells with a CD30+/CD15+ immunophenotype.
- These cells also exhibited specific B-cell marker expression: diffusely weak PAX5+, focally weak Oct-2+, and negative for BOB.1.
Findings:
- The immunophenotype of the cutaneous lesions matched the diagnostic lymph node biopsy.
- The expression pattern of PAX5, Oct-2, and BOB.1 confirmed the diagnosis of cutaneous Hodgkin lymphoma.
- This is the first report detailing this specific marker combination in cutaneous Hodgkin lymphoma.
Implications:
- The B-cell markers PAX5, Oct-2, and BOB.1 are valuable tools for diagnosing cutaneous Hodgkin lymphoma.
- Accurate diagnosis is crucial for appropriate treatment and management of skin manifestations of cHL.
- This finding aids in differentiating cHL from other CD30-positive cutaneous lymphomas.
Abstract:
In lymph nodes, classical Hodgkin lymphoma can typically be distinguished from non-Hodgkin lymphoma (NHL) by the presence of Hodgkin and Reed-Sternberg cells that co-express CD30 and CD15. However, anaplastic large cell lymphoma (ALCL) and diffuse large B-cell lymphoma (DLBCL) can show identical features, and some cases of classical Hodgkin lymphoma lack CD15 expression, rendering them difficult to differentiate from CD30-positive NHL. The differential diagnosis of cutaneous Hodgkin lymphoma similarly includes ALCL and DLBCL, and, additionally, tumors of mycosis fungoides. Recent studies have shown that classical Hodgkin lymphoma is of B-cell origin in virtually all cases, and shows at least focal weak expression of the B-cell marker PAX5 and often focal weak expression and no expression of the B-cell markers Oct-2 and BOB.1, respectively. All three of these markers are almost invariably absent in T-cell lymphomas and are strongly expressed in B-cell lymphomas. We report a 40-year-old man with classical Hodgkin lymphoma who developed cutaneous nodules. A biopsy from one revealed Hodgkin/Reed-Sternberg cells with a similar immunophenotype to the diagnostic lymph node biopsy, namely CD30+/CD15+, diffusely but weakly PAX5+, focally weakly Oct-2+ and lacking BOB.1 expression, thereby confirming a diagnosis of cutaneous Hodgkin lymphoma. To our knowledge, this is the first report of the expression pattern of the combination of PAX5, Oct-2 and BOB.1 in the context of cutaneous involvement by Hodgkin lymphoma.
