Hodgekin's Lymphoma Flashcards
Immunophenotype of Reed-Sternberg cells in Classical Hodgekin’s lymphoma
CD15 +ve (NB also expressed by myeloid cells)
CD30 +ve (100%)
PAX5 +ve
CD45 -ve
Mostly Bcl-6 -ve
Mostly CD20 -ve (25% +ve)
ALK -ve
Oct2 -ve
BOB1 -ve
CD10 -ve
CD79a usu negative (sometimes stains classic RS cells in 25%)
EBV+ve in lymphocyte depletion type, mostly +ve in MCHL, less so in nodular sclerosing type
Immunophenotype of RS cells in nodular lymphocyte predominant HL
Absent germinal centres (cf LRCHL)
Popcorn cells with rosette of T cells
B cell background
CD15-ve
CD30-ve
MUM1 -ve (but T cell rosettes +ve)
CD20+ve
CD79a+ve
CD45+ve
PAX-5 +ve
Bcl-6 +ve
EMA sometimes +ve
Oct2 and Bob1 +ve
EBV -ve
Nodular lymphocyte predominant HL features
Nodular or less commonly nodular and diffuse
Moth-eaten nodules
Males, usu 30s -50s
Usu single enlarged LN (mediastinal involvement uncommon)
Responds to radiotherapy
Small lymphocytes with scattered L+H/popcorn cells
Internodular T-cell areas
Prominent epithelioid histiocytes/granulomas
Rosette of CD20-ve T-cells around CD+ve L+H cells makes identifying them easier
DDs: progressive transformation of germinal centres, nodular lymphocyte rich HL
Lymphocyte rich classical HL
M>F, older age group
Lack B symphoms and bulky disease
Small lymphocytes in diffuse or nodular pattern
No necrosis/fibrosis
Nodules have irregular borders and have expanded mantle zones
Residual germinal centres (cf NLPHL)
collarette of T cells around RS cells
Nodular sclerosis HL
Usu adolescents and young adults, bimodal age distribution (
M=F
Commonly presents with supraclavicular/cervical nodes with underlying mediastinal mass
B symptoms in 40%
Collagen bands surround nodules
LN may show partial involvement
Lacunar cell variant of RS cells (lacunar is fixation artefact)
Occasionally lacunar cells can aggregate and look like granulomas (syncytial variant)
Background T-cell lymphocytes
May be in interfollicular areas with follicular hyperplasia - easily missed
Approx 40% associated with EBV
DDx: anaplastic large cell lymphoma, primary mediastinal large B-cell lymphoma, DLBCL
Mixed cellularity HL
Male predominance
Subtypes most commonly in HIV patients
Mixed inflamm cell infiltrate
Background T cells
Granuloma-like clusters of epithelioid histiocytes.
Owl-eye RS cells, Hodgekin’s cells, occ lacunar cells
Bands of sclerosis absent, may have interstitial fibrosis
May be in interfollicular areas with follicular hyperplasia - easily missed (look for focal collections of histiocytes)
More often associated with EBV (70%)
DDx: peripheral T-cell lymphoma,
Lymphocyte depletion HL
More frequent in developing countries
Here, seen in HIV patients
Male, older patients (exp HIV)
B symptoms, lymphadenopathy, advanced stage disease
2 histological types - reticular and diffuse
Reticular type - hypercell, lots of pleomorphic large cells some resembling RS cells, necrosis, fibrosis and fibrillary matrix
Diffusetype - hypocellular, pink proteinaceous material, few classic/RS cells
