Hodgkin Lymphoma

HODGKIN LYMPHOMA

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.