Hodgkin’s Lymphoma or Disease (HD)
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Hodgkin’s Lymphoma or Disease (HD)
Pathology of lymph nodesA. Infections
1. Bacterial 2. Fungal, mycobacterial
B. Reactive hyperplasias 1. Exaggerations of normal histology. Expansion of all regions or
selective expansion of one. Some types characteristic of certain diseases, but most not
2. Follicular hyperplasia increase in number and size of germinal centers, spread into paracortex, medullary areas
a. Collagen vascular diseases, b. Systemic toxoplasmosis, c. Syphillis
3. Interfollicular hyperplasia- paracortex- a. Skin diseases b. Viral infections c. Drug reactions
4. Sinus histiocytosis- expansion of the medullary sinus histiocytes- a. Adjacent cancer b. Infections
C. Sarcoidosis D. Metastatic tumors E. Malignant lymphomas (Non-Hodgkins' lymphomas-NHLs) and
Hodgkin's lymphoma
Classification Non-Hodgkin’s Lymphoma
T cell NHL B cell NHL Miscellaneous NHL
Hodgkin’s Lymphoma Nodular sclerosis Hodgkin lymphoma Mixed cellularity Hodgkin lymphoma Lymhocyte predominant Hodgkin Lymphoma Lymphocyte-rich classical Hodgkin lymphoma Lymphocyte depleted Hodgkin lymphoma
Hodgkin’s Lymphoma(Hodgkin's disease) (Thomas Hodgkin ;1832)Less common than NHL; approximately 10,000 cases per year Incidence with respect to age bimodal, with one
peak in late adolescence, young adulthood, second peak in sixth decade A potentially curable malignant lymphoma with distinct histology, biologic behavior, and clinical characteristics.
Young adults (male predominance) particularly evident in children, where 85% of the
cases are males.
Palpable, painless, firm lymphadenopathy (rubbery adenopathy): cervical area (60-80%), axilla (6-20%), inguinal area (6-20%). Waldeyer ring or occipital or epitrochlear
areas is observed infrequently. Splenomegaly may be present. Patients may have hepatomegaly.
Clinical findings
Central nervous system (CNS) symptoms or signs may be due to paraneoplastic syndromes, including cerebellar degeneration, neuropathy, Guillain-Barré syndrome, multifocal leukoencephalopathy.
Fever (classic Hodgkin's fever is the "Pel-Ebstein fever", or intermittent spiking fever)
Pruritus Eosinophilia A complication of AIDS.
ETIOLOGY The etiology of HD is unknown. Infectious agents, especially the Epstein-Barr virus
(EBV) Previous history of Epstein-Barr Virus Infectious
Mononucleosis Almost 100% of HIV-associated HD cases are EBV-
positive. Patients with HIV infection have a higher incidence
However, HD is not considered an AIDS-defining neoplasm.
Genetic predisposition Approximately 1% of patients with HD have a family
history of the disease. HLA-DP alleles are more common. It is now agreed that Hodgkin lymphoma is a
neoplasm arising from germinal center B cells.
A malignant disease with four histologic subtypes; to make the diagnosis need to see an acceptable Reed-Sternberg cell (the malignant cell of Hodgkin's disease) in the proper reactive cellular background, consisting of
small lymphocytes, histiocytes, plasma cells, eosinophils.
Reed-Sternberg cell
The Reed-Sternberg cells represent a clonal proliferation of B lymphocytes that derive from the germinal centers of lymph nodes and that have lost their ability to express their antibodies because of the introduction of multiple somatic mutations.
Large binucleated cell with large, red owl-eye nucleoli (same size as a small
lymphocyte) with surrounding halo multilobed nucleus (often appears "binucleate"), with
lobes appearing as mirror images of one another Pink-to-lavender cytoplasm.
Reed-Sternberg variants Mononuclear Reed-Sternberg-like cells ("Hodgkin cells")
have single-lobed nuclei and one nucleolus. They may be seen in any variant of Hodgkin's disease.
LP cells ("L&H cells") have scanty cytoplasm, big knobby nuclei, and small nucleoli. They are seen in lymphocyte predominance Hodgkin's disease.
Lacunar Reed-Sternberg cells have abundant, pale cytoplasm, and single, hyperlobated nucleus with small nucleoli. They are seen in nodular sclerosis Hodgkin's disease.
Polylobated Reed-Sternberg cells (popcorn cells) look like good Reed-Sternberg cells, except that the nucleoli aren't so impressive. They are typical of mixed cellularity Hodgkin's disease.
Pleomorphic Reed-Sternberg cells are anaplastic versions of the familiar form. They make up the bulk of the tumor in lymphocyte depletion Hodgkin's disease.
Lymphocytic and Hystiocytic (LH) cell variant Reed Sternberg cells in HD(pop-corn cells)
Lacunar variant
Hodgkin Lymphoma Non-Hodgkin Lymphoma
More often localized to a single axial group of nodes (cervical, mediastinal, para-aortic)
More frequent involvement of multiple peripheral nodes
Orderly spread by contiguity Noncontiguous spread
Mesenteric nodes and Waldeyer ring rarely involved
Mesenteric nodes and Waldeyer ring commonly involved
Extranodal involvement uncommon Extranodal involvement common
Clinical Differences Between Hodgkin and Non-Hodgkin Lymphomas
WHO Classification of HD
Microscopical types : Lymphocyte predominant (at low stage) Lymphocyte rich Nodular Sclerosis (often a mediastinal mass). Mixed cellularity (at low or high stage). Lymphocyte depleted (at high stage).
Until the late stages of the disease, the tumor masses are composed primarily of inflammatory cells responding to the cancer.
Lymphocyte (B)
Reed-Sternberg cells
Other cells Differential diagnosis
Lymphocyte predominance
Monotonous, Small cells
Rare (LP cells)
Small lymphocyteHistiocytes
Small lymphocytic lymphoma
Mixed cellularity
Mixture of cells
Many (polylobated)
Lymphocytes, plasma cells, eosinophils, histiocytes
Infectious mononucleosis
Lymphocyte depletion
Less lymphocyte
Present (pleomorphic)
Anaplastic B-cells, lots of fibers, few lymphocyte
Nodular sclerosis
Less cell more fiber (collagen extending into the node)
Present (lacunar)
cellular islands containing lymphocytes, histiocytes, eosinophils, and plasma cells
Hodgkin's Disease
Type Clinical Features Frequency Prognosis
Nodular sclerosis
Painless Lymphadenopathy,more common in women
Most frequent type (68%)Good, most are stage I or II
Mixed cellularity
Most frequent in older persons, second most frequent overall (23%)
Fair, most are stage III
Lympho-cyte predomi-nance
Young males, cervical nodes diffuse or vaguely nodular
Uncommon (7%)
Good, most are stage I or II
Lympho-cyte depletion
Uncommon (2%)Poor, most are stage III or IV
Painless Lymphadenopathy
Painless Lymphadenopathy
Nodular Sclerosing HD
Lymphocyte predominant HD
Lymphocyte depledet HD
Immunhistochemistry RS cells are expressing CD-15
Positive staining for CD15 (Leu-M1) and CD30 (Ki-1)
Negative staining for CD45
Staging
Stage I one node group or organ Stage II one side of the diaphragm Stage III both sides of the diaphragm Stage IV marrow, or two extra-lymphatic organs.
Hodgkin's disease spreads predictably along contiguous groups of lymph nodes.
As it spreads, there may be transformation: Lymphocyte predominance turns into mixed
cellularity or lymphocyte depletion. Mixed cellularity turns into lymphocyte depletion. Nodular sclerosis generally keeps its type.
Hodgkin’s disease; cervical lymph node involvement
Hodgkin's Disease - StagingStage 1 Only a single lymph node site or extranodal site is
involved
Stage 2 Two or more lymph node sites on one side of the diaphragm are involved, or limited contiguous extranodal site involvement
Stage 3 Lymph node sites on both sides of the diaphragm are involved, with splenic or limited contiguous extradodal site involvement, or both
Stage 4 Lymph node sites on both sides of the diaphragm are involved, with splenic or limited contiguous extradodal site involvement, or both
Hodgkin’s Disease (Liver&Lymph node)
Complications of HDMostly during or after treatment.
Irradiation-related complications: Cardiac complications (coronary artery disease, chronic
pericarditis, pancarditis, valvular heart disease, and defects in the conduction system)
Pulmonary complications (dyspnea) Breast cancer Hypothyroidism Immunodeficiency
Chemotherapy-reladed complications: Cardiac complications (congestive heart failure) Pulmonary complications (interstitial pneumonitis) Bone marrow complications (Myelodysplasia, acute myeloid
leukemia) Infertility Breast cancer Immunodeficiency Non-Hodgkin lymphoma.
Infectious complications Sepsis: Patients who have undergone splenectomy
are predisposed to bacterial sepsis secondary to encapsulated microorganisms (especially pneumococcal organisms)
Herpes zoster.
Other complications: Lung cancer Malignant melanoma Other cancers.
Thank you!
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