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Hodgkin lymphoma subtypes under the microscope | CION Cancer Clinics
Classical Hodgkin lymphoma has four subtypes: nodular sclerosis, mixed cellularity, lymphocyte-rich and lymphocyte-depleted. A separate, rarer type is nodular lymphocyte-predominant Hodgkin lymphoma. The subtype describes what the pathologist sees in your lymph node. For classical Hodgkin, treatment is planned mainly on stage and risk factors, not subtype alone. This page explains each name on your histology report. At CION Cancer Clinics, our haematology team plans myeloma and lymphoma care with you, discussed at a tumour board and explained in plain words.
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Medically reviewed by Dr. Basudev PokhrelConsultant Haematologist · last reviewed September 2026, next review due September 2027
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On this page
- What are the subtypes of Hodgkin lymphoma?
- What does each classical subtype look like?
- What do the words on the histology report mean?
- How is the subtype worked out?
- Does the subtype change my treatment?
- What do people often misread about subtypes?
- What can the histology report not tell you?
- Common questions about Hodgkin lymphoma subtypes
The short answer
What are the subtypes of Hodgkin lymphoma?
Hodgkin lymphoma has two main types. Classical Hodgkin lymphoma is split into four subtypes: nodular sclerosis, mixed cellularity, lymphocyte-rich and lymphocyte-depleted. The second type, nodular lymphocyte-predominant Hodgkin lymphoma, is rare and is treated as a separate disease.
Where the names come from
The names describe what the pathologist, the doctor who reads tissue under a microscope, sees in your lymph node. They look at the large abnormal cells, how many normal immune cells surround them, and whether bands of scar-like tissue run through the node. Each subtype has its own mix of these features.
Why the subtype is written on your report
The subtype tells your haematologist something about where the disease tends to appear, who it tends to affect and how it may behave. For classical Hodgkin, though, today's treatment is planned mainly on the stage and your risk factors, not the subtype alone. For the nodular lymphocyte-predominant type, the plan is often quite different.
If your report only says "classical Hodgkin lymphoma" with no subtype, that is common and does not mean something was missed.Under the microscope
What does each classical subtype look like?
All four share the same key finding: large Reed-Sternberg cells scattered among many normal immune cells. What differs is the background.
Nodular sclerosis
Bands of scar-like tissue divide the node into rounded nodules. It is the most common subtype in most countries.
Often seen in
- Teenagers and young adults
- Nodes in the chest and neck
Mixed cellularity
Many different immune cells are mixed together with the abnormal cells, without the scar bands. It is seen more often in India than in Western countries.
Often seen in
- Children and older adults
- Cases linked to Epstein-Barr virus
Lymphocyte-rich
The background is mostly small normal lymphocytes, a type of white blood cell. It is uncommon and is often found at an early stage.
Can look like the nodular lymphocyte-predominant type, so the stains matter.Lymphocyte-depleted
There are many abnormal cells and few normal ones. It is the rarest subtype and is more often found at a later stage, in older people or people with a weakened immune system.
Not sure whether this applies to you?
Ask an oncologistOn your report
What do the words on the histology report mean?
- Histology or histopathology
- The study of tissue under a microscope. The report is the written result.
- Reed-Sternberg cells
- The large abnormal cells that mark classical Hodgkin lymphoma. Some have two nuclei that look like a pair of eyes.
- CD30 and CD15
- Marker proteins on the abnormal cells. Both are usually present in classical Hodgkin lymphoma.
- CD20
- A marker usually present in the nodular lymphocyte-predominant type and usually absent in classical Hodgkin.
- EBER or EBV positive
- The Epstein-Barr virus, which causes glandular fever, was found inside the abnormal cells. It is a description, not an infection you can pass on.
- Sclerosis or fibrosis
- Scar-like bands of tissue inside the node.
In the lab
How is the subtype worked out?
Tissue is taken
A surgeon removes a whole lymph node, or takes a core of tissue with a wider needle. The abnormal cells are few, so more tissue gives a clearer answer than a thin needle sample.
Thin slices are stained
The tissue is set in wax, cut into very thin slices and stained so the cells and the node's structure can be seen under the microscope.
Marker tests are added
Special stains, called immunohistochemistry or IHC, show which marker proteins the abnormal cells carry. This step can add several days to the report.
The report is signed out
The pathologist names the type and, where possible, the subtype. In a difficult case they may ask a colleague or a specialist centre to review the slides.
What it means for treatment
Does the subtype change my treatment?
For classical Hodgkin lymphoma, usually not by itself. All four classical subtypes are generally treated along the same lines. The choice of chemotherapy, how many courses and whether radiotherapy is added depend mostly on the stage, whether there are symptoms such as fevers, sweats and weight loss, the size of the largest mass, blood tests and your age and fitness.
Where the subtype does help
It can hint at patterns. Nodular sclerosis often involves a mass in the chest, so your team looks carefully at the scan there. Mixed cellularity and lymphocyte-depleted disease are more often found at a later stage, so staging tests are especially thorough. These are tendencies, not rules for any one person.
Where the type changes everything
The nodular lymphocyte-predominant type is different. Early disease may be treated with radiotherapy alone, and some people are carefully watched. That is why your haematologist confirms the type before planning.
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Commonly believed
What do people often misread about subtypes?
"Our subtype sounds rare, so it must be the worst one."
A rare name is not the same as a poor outlook. What shapes the outlook most is the stage, your symptoms, your blood tests and how the disease responds to the first courses of treatment.
"EBV positive means the family has caught the cancer virus."
Most adults carry Epstein-Barr virus without harm. Finding it inside the abnormal cells describes the lymphoma. Relatives do not need testing and are not at risk from living with you.
"A needle test was enough, we do not need a node removed."
Sometimes it is, but often it is not. If the report cannot name the type clearly, a larger sample avoids treating the wrong disease. Ask your team whether your sample was enough.
"The subtype tells us how many courses of chemotherapy are needed."
For classical Hodgkin, the stage and risk factors decide that, along with a PET-CT scan partway through treatment.
Being straight with you
What can the histology report not tell you?
A histology report names the disease. It does not give the stage, which comes from scans and blood tests, and it does not give a prognosis, the likely course of the illness. It also cannot choose the treatment by itself.
When a second review makes sense
Ask about sending the slides and tissue blocks for a second opinion if the report uses words such as "suggestive of" or "cannot exclude", if the subtype is left open when the team needs it, or if the illness is not behaving as expected. At CION, the haematology team reviews the report and discusses your case at a tumour board, a meeting of specialists.
Questions we are asked
Common questions about Hodgkin lymphoma subtypes
Which Hodgkin lymphoma subtype is the most common?
Nodular sclerosis is the most common classical subtype in most countries, and it often affects teenagers and young adults. Mixed cellularity is seen more often in India than in Western countries, especially in children and older adults. Your own subtype is on the histology report.
Is one subtype easier to treat than another?
Across the classical subtypes, treatment is broadly similar and responds well for many people. Differences in outlook come mostly from the stage, symptoms, blood tests, age and response to treatment. Ask your haematologist what these mean in your case rather than judging by subtype name.
My report says "classical Hodgkin lymphoma, not otherwise specified". Is that a problem?
Usually not. It means the pathologist confirmed classical Hodgkin but the sample did not show a clear subtype pattern. This is common with smaller samples. Since treatment for classical Hodgkin rests mainly on stage, the plan can usually go ahead without it.
Why did the report take more than a week?
Hodgkin lymphoma needs extra marker stains after the first look under the microscope, and sometimes a second pathologist's review. Each step adds time. A careful report is worth the wait, because the type shapes every decision after it. Ask the team for an expected date if you have not been given one.
Can the subtype change if the lymphoma comes back?
The classical subtype usually stays the same. If the disease returns, or behaves in an unexpected way, a new biopsy is often advised. This checks whether it is the same lymphoma, a different type, or something unrelated such as an infection.
Does EBV positive change my treatment?
Not usually on its own. Epstein-Barr virus in the abnormal cells is a feature of the lymphoma and is more common in mixed cellularity. It is noted on the report, and your haematologist reads it alongside everything else. It is not a reason for relatives to be tested.
Can we get the slides reviewed at another centre?
Yes. The hospital that did the biopsy keeps the slides and tissue blocks, and they can usually be released for review on request. Ask your treating team to arrange it, or ask for a letter so you can request them yourself.
What should I bring to my first haematology appointment?
Bring the full histology report, any marker or IHC report, scan reports and CDs, recent blood tests and a list of your medicines. Note any fevers, night sweats or weight loss and when they started. A family member who can take notes is a real help.
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Sources
- American Cancer Society — What Is Hodgkin Lymphoma?
- Cancer Research UK — Types of Hodgkin lymphoma
- National Cancer Institute — Hodgkin Lymphoma Treatment (PDQ) - Patient Version
- Leukemia & Lymphoma Society — Hodgkin Lymphoma
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
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