Hodgkin lymphoma has some characteristics that are different from non-Hodgkin lymphoma.
• May present similar to infection (with fever)
• Spread is contiguous to adjacent node groups
• No leukemic state
• Extranodal spread is uncommon
The malignant cells are the diagnostic Reed-Sternberg cells; these malignant cells are intermixed with reactive inflammatory cells. The Reed-Sternberg cell is a large malignant tumor cell that has a bilobed nucleus with a prominent large inclusion-like nucleolus in each lobe.
Hodgkin lymphoma classification:
• Lymphocyte-rich type (rare): composed primarily of reactive lymphocytes; associated with Epstein-Barr virus (40% of cases)
• Lymphocyte-predominant type: has lymphohistocytic variants (L&H cells, called “popcorn cells”) and a unique phenotype (CD45+, CD15-, CD30-, CD20+)
• Mixed cellularity type: occurs in middle-aged and older males; the increased number of eosinophils is related to IL-5 secretion
• Lymphocyte-depleted type: presents with abdominal adenopathy; Reed-Stern-berg cells predominate
• Nodular sclerosis type (most common subtype (65–70% of cases)): is only type in which females > males
°° Lymph node has broad collagen bands
°° Reed-Sternberg cell has clear space in the cytoplasm (lacunar cell)
Hodgkin lymphoma has a bimodal age group distribution (age late 20s and >50).
Patients usually present with painless enlargement of lymph nodes.
Poor prognosis is directly proportional to the number of Reed-Sternberg cells pres-ent. Survivors of chemotherapy and radiotherapy have increased risk for secondary non-Hodgkin lymphoma or acute leukemia.