What Is a Histology Report?
After a lymph node biopsy, the tissue goes to a pathology lab. A pathologist examines it under a microscope. They describe the cells, how they are arranged, and which protein markers appear on the cell surface. The written result is your histology report.
For lymphoma, this report is the foundation of your treatment plan. It tells your care team what type of lymphoma you have and how the cancer cells behave. Your treatment decisions – which drugs, which protocols, which scans – all flow from what this report says.
| Feature | Hodgkin Lymphoma (HL) | Non-Hodgkin Lymphoma (NHL) |
|---|---|---|
| Hallmark cell finding | Reed-Sternberg cells present | Reed-Sternberg cells absent |
| Typical cell of origin | B-cells (almost all cases) | B-cells, T-cells, or NK-cells |
| Disease spread at diagnosis | Usually contiguous, stage by stage | More often disseminated (Stage III or IV) |
| Growth pattern | Relatively uniform | Ranges from slow-growing (indolent) to fast-growing (aggressive) |
| Most common subtype | Classic HL, nodular sclerosis type | Diffuse large B-cell lymphoma (about 30% of cases) |
| Stage I 5-year relative survival | 92.7% | Varies by subtype |
Stage I HL 5-year survival from NCI SEER Cancer Stat Facts: Hodgkin Lymphoma. DLBCL prevalence (approximately 30%) from Vitolo et al., Annals of Oncology, 2008. Cell of origin and spread pattern from Mayo Clinic.
The Single Most Important Finding: Reed-Sternberg Cells
The main difference between Hodgkin and non-Hodgkin lymphoma is one cell type: the Reed-Sternberg cell.
Reed-Sternberg cells are large, abnormal lymphocytes. Under the microscope, they often appear with two nuclei. Each nucleus contains a prominent, round structure called a nucleolus. Pathologists sometimes call this the owl-eye pattern because it looks so distinctive on the slide. According to a StatPearls reference published in the National Library of Medicine, the presence of Reed-Sternberg cells is essential for a diagnosis of Hodgkin lymphoma – though their presence alone is not sufficient without the full clinical picture.
If your report shows Reed-Sternberg cells, you have Hodgkin lymphoma. If not, it is non-Hodgkin lymphoma. That single cell type determines your diagnosis.
Hodgkin Lymphoma: Classic and Nodular Types
The World Health Organization recognizes two main categories of Hodgkin lymphoma. The most common is classic Hodgkin lymphoma. It has four subtypes based on what the tissue surrounding the Reed-Sternberg cells looks like:
- Nodular sclerosis: The most common subtype. Bands of scar-like tissue divide the lymph node into sections.
- Mixed cellularity: A mix of immune cell types surrounds the Reed-Sternberg cells.
- Lymphocyte-rich: Few Reed-Sternberg cells and many normal lymphocytes. Often caught at an early stage.
- Lymphocyte-depleted: Rare. Fewer normal lymphocytes and more Reed-Sternberg cells. Usually linked to advanced disease.
The second category is nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL). It is less common and behaves differently from classic HL. NLPHL tends to grow more slowly and has a distinct immunophenotype on IHC testing. The pathology report will name the specific subtype. Your oncologist will explain how each subtype affects your treatment options and expected course.
Non-Hodgkin Lymphoma: A Large Family of Diseases
Non-Hodgkin lymphoma is not one disease. It is a broad category that covers many lymphoid cancers behaving very differently from each other. Cancer Research UK organizes NHL into two main categories based on the cell of origin.
B-cell lymphomas are the most common. The most frequently diagnosed subtype is diffuse large B-cell lymphoma (DLBCL). It is an aggressive lymphoma that grows quickly – but it often responds well to chemotherapy. A review in Annals of Oncology found DLBCL accounts for approximately 30% of all newly diagnosed NHL cases. The most common slow-growing (indolent) B-cell subtype is follicular lymphoma. Follicular lymphoma arises from germinal center B-cells. Some patients with follicular lymphoma stay under observation for months or even years before they start treatment.
Other notable B-cell subtypes include mantle cell lymphoma and Burkitt lymphoma. Burkitt lymphoma is among the fastest-growing lymphomas and requires very prompt treatment. Mantle cell lymphoma behaves somewhere between indolent and aggressive and is often caught at an advanced stage. Your histology report will specify which B-cell subtype applies to your case.
T-cell and NK-cell lymphomas are less common overall. They tend to be more aggressive and are treated differently than B-cell lymphomas. Your report will clearly state the cell of origin – and this single item is one of the most important pieces of information in the document.
What the Grade Means
Grade describes how abnormal the cancer cells look under the microscope and how quickly they appear to be dividing.
- Low grade (indolent): Cells look closer to normal. They tend to grow slowly. Treatment may be delayed while the patient is closely monitored.
- High grade (aggressive): Cells look very abnormal and divide quickly. Treatment usually starts soon after diagnosis.
High-grade lymphomas often respond better to chemotherapy than low-grade ones, which may seem backward. An aggressive NHL like DLBCL may be cured with standard combination chemotherapy. A low-grade NHL like follicular lymphoma can be managed for years but is rarely cured by conventional therapy alone. This is why your oncologist may push for quick treatment with aggressive lymphomas but take a wait-and-see approach with slow-growing ones.
Follicular lymphoma is graded 1, 2, or 3A/3B according to the classification system maintained in the NCI SEER Hematopoietic and Lymphoid Neoplasm Database. Grade 3B follicular lymphoma is treated as an aggressive lymphoma, similar to DLBCL, and is not managed with a watch-and-wait approach.
Immunohistochemistry: The Protein Markers on Your Report
Immunohistochemistry (IHC) is a lab method that uses antibodies to tag specific proteins on cancer cells. Each marker tells what type of cell it is and which therapies might work. A review published in PubMed Central describes IHC as a key tool for classifying lymphomas into B-cell, T-cell, and NK-cell categories and for identifying treatment targets.
Common IHC markers you may see listed on your report:
- CD20: Found on most B-cell lymphomas. A positive result means the cancer may respond to rituximab, a monoclonal antibody therapy used widely in NHL treatment.
- CD30 and CD15: Usually positive in classic Hodgkin lymphoma. They help confirm that Reed-Sternberg cells are genuine HL cells rather than a look-alike condition found in some non-Hodgkin subtypes.
- CD3: A T-cell marker. A positive result points toward T-cell lymphoma and changes the treatment approach.
- Ki-67: Measures the proportion of cells that are actively dividing at the time of biopsy. A higher percentage suggests a more aggressive lymphoma. This helps confirm whether the lymphoma is indolent or high-grade.
These markers appear as a table or list in your pathology report. Your oncologist interprets them as a group alongside the rest of the clinical data – not one at a time. If a term on the list is unfamiliar, write it down and ask your care team to explain its significance for your specific subtype.
Staging: How Far Has the Lymphoma Spread?
The Ann Arbor staging system is used for both HL and NHL. It describes how widely the lymphoma has spread through the body.
- Stage I: One lymph node region is affected.
- Stage II: Two or more lymph node regions on the same side of the diaphragm are involved.
- Stage III: Lymph node regions on both sides of the diaphragm are involved.
- Stage IV: Lymphoma has spread beyond the lymph nodes to organs such as the bone marrow, liver, or lungs.
Your report may also note B symptoms: unexplained fevers, drenching night sweats, or significant unexplained weight loss. B symptoms generally indicate more active disease and may influence the intensity of treatment your oncologist recommends.
Mayo Clinic notes that compared to Hodgkin lymphoma, non-Hodgkin lymphoma is more likely to be at a disseminated stage at the time of diagnosis. This does not necessarily reflect how long the cancer has been growing. NHL simply spreads in less predictable patterns than HL, which tends to move from one adjacent lymph node region to the next.
What Happens After You Receive the Report
A histology report is one part of your diagnostic picture. Your oncologist will combine it with imaging – usually a PET-CT or CT scan – a bone marrow biopsy, blood tests including LDH levels and a complete blood count, and your overall health and age. Together, these determine the treatment plan. No single piece of the report should be read in isolation.
Before your first oncology appointment after receiving the report, it can help to write down the subtype name, the grade, the stage, and the IHC markers listed. Note any terms you did not understand and bring the written report to the appointment. Oncologists welcome specific questions about what individual findings mean for treatment options and expected outcomes.
Many patients begin thinking ahead to life during and after treatment at this early stage. Cognitive changes during chemotherapy are a common concern for lymphoma patients. The article on Managing Chemo Brain During Lymphoma Treatment covers practical strategies used alongside standard care.
Hodgkin lymphoma survivors face some distinct long-term health concerns after treatment ends. The article on Managing Metabolic Syndrome in Hodgkin Lymphoma Survivors outlines what follow-up monitoring typically involves in the years after finishing therapy.
Integrative Support During the Diagnostic Phase
Some patients ask about complementary approaches while waiting for a treatment plan. No supplement or herbal product has been shown to treat lymphoma or replace standard chemotherapy or immunotherapy. However, some patients and their oncologists discuss evidence-based nutraceuticals as part of a broader integrative care plan – not as a replacement for conventional therapy, but as an adjunct discussed openly with the care team. If that conversation is relevant to your situation, you can browse Oncostore’s selection of Integrative Oncology products as a starting point for those discussions.
If you are on prescription medication, pregnant, or breastfeeding, speak with your clinician before starting any new supplement or herbal product. This article is for general information and is not a substitute for medical advice. Always consult your oncologist or care team about your specific situation.
