HODGKINS LYMPHOMA

Definition
Neoplastic disorder of lymphoid tissue
REED-STERNBERG CELLS in the
appropriate cellular background of the
involved tissue

Whats the difference between

NHL & HL???

Differences
Hodgkins Lymphoma

Non Hodgkins Lymhoma

Localized to single axial gp of

LNs

Multiple peripheral LNs

involved

Contiguous spread

Non contiguous spread

Mesenteric nodes & Waldeyer

ring rarely involved

Mesenteric nodes & Waldeyer

ring commonly involved

Extra nodal presentation rare

Extra nodal presentation

common

Clinical Presentation
Bimodal age presentation
Risk factors
Epstein barr virus
HIV infection

Almost always begins in the lymph nodes

Cervical and supraclavicular 70-75%
Axillary and mediastinal 5-10%
Abdominal and inguinal <5%

Clinical Presentation
Contiguous, slow growing, rubbery, discrete,
painless LAD
B (systemic) symptoms fever, wt loss & night
sweats
Pruritis & Pain after alcohol ingestion
Liver involvement rare in the absence of splenic
involvement

WHO Classification
Classical
Nodular sclerosis
Mixed cellularity
Lymphocyte rich
Lymphocyte depletion

Lymphocyte predominance

A possible model of pathogenesis

transforming
event(s)
EBV?

germinal
centre
B cell

loss of apoptosis

cytokines
RS cell

inflammatory
response

Reed-Sternberg (RS) Cell

Germinal center or post germinal center B
cells
Release factors accumulation of reactive
lymphocytes, macrophages & granulocytes
>90% of tumour cellularity

Reed-Sternberg (RS) Cell

Reed-Sternberg (RS) Cell

Reed-Sternberg (RS) Cell

Large cell
Multiple nuclei or single nucleus with multiple
nuclear lobes
Large inclusion like
nucleolus
Cytoplasm-adundant

Variants of RS Cell
Mononuclear variant single nucleus with
large inclusion like nucleolus

Variants of RS Cell
Lacunar cell
Delicate, folded or multilobed nuclei
Abundant pale cytoplasm

Variants of RS Cell
Lymphohistiocytic variant (L&H cells)
Aka Popcorn cells
Polypoid nucleus
Inconspicuous nucleoli

Variants of RS Cell
Mummified Cells Cell shrinks & becomes
pyknotic

Nodular Sclerosis

MC 65-70%
Adolescents & young adults F>M
LN, Spleen , liver, marrow, mediastinum
Lacunar variant
Bands of collagen dividing LN into
circumscribed nodules
CD15 & 30 Positive
Prognosis - Excellent

Nodular Sclerosis

Mixed Cellularity

20-25%
Older patients M>F
Systemic symptoms +
EBV +
Classic & Mononuclear variant
Heterogenous cellular infiltrate T cells,
eosinophils, macrophages, plasma cells
CD15 & 30 Positive
Prognosis - Good

Mixed Cellularity

Lymphocyte-Rich

Uncommon
Older patients M>F
EBV +
Reactive lymphocytes Majority population
CD15 & 30 Positive
Prognosis Good to excellent

Lymphocyte Depletion

Least common <5%

Older patients M>F
In HIV+ individuals
EBV +
Systemic symptoms +
Paucity of lymphocytes, abundance of RS cells
CD15 & 30 Positive
Prognosis Less favourable

Lymphocyte Depletion

Lymphocyte Predominance

Uncommon 5%
Young males
Cervical & axillary LAD
L&H cells
Numerous reactive B cells & follicular dendritic
cells
CD15 & 30 Negative
CD20 Positive
Prognosis - Excellent

Lymphocyte Predominance

Staging

Diagnosis
Blood investigations: CBC, PS, ESR, LFT,
KFT, LDH, Urate , Ca
Lymph node biopsy
Chest X-ray, CT of thorax, abdominal, pelvis
and bone marrow biopsystaging of HL

Treatment
Chemotherapy - ABVD
Radiotherapy

Prognosis
Stage I & IIA 5yr survival rate 90%
Stage IIIB & IV 5yr survival rate 60-70%