Hodgkin Lymphoma

Question 1

Cell of origin of LP cells

Answer 1

germinal center B cells

Question 2

Clinical of NLPHL

Answer 2

75% are male, age 25-50
5% of all Hodgkin lymphoma
Few show B symptoms

Question 3

Morphology of NLPHL

Answer 3

• vague large nodules with “moth-eaten” appearance
• cannot be completely diffuse, requires at least focal modularity
• majority of cells in the nodules are benign B cells
• mixed inflammatory cells (eos, plasmas) are rare
• association with PTGC
• ddx: T cell histiocyte rich large b cell

Question 4

Immunophenotype of LP cells

Answer 4

-B cell markers
-BCL6
-CD45
-EMA in 50%
-ring of CD57, PD1 T cells
Negative for: CD15, CD30 (<5% cases may), EBV

Question 5

Prognosis of NLPHL

Answer 5

• Indolent, responsive to tx, with frequent local recurrence
• stage I-II>80% 10 year overall survival
• ~5% transform to DLBCL

Question 6

Treatment of NLPHL

Answer 6

• stage IA: involved field radiation therapy (IFRT) 30 Gy

- all other stages: 2 cycles ABVD + IFRT 20 Gy

Question 7

Cell of origin of RS/Hodgkin cells

Answer 7

• germinal center B cells with lost B cell phenotype (down regulation of B cell specific transcription factors)
• exhibit over expression of a variety of cytokines/chemokines that result in abundant reactive inflammatory cells seen in classical HL

Question 8

Classical Hodgkin Lymphoma Clinical

Answer 8

• 95% of all Hodgkin lymphoma
• all except NS show male predominance
• bimodal age 15-40 and late in life
• 40% have B symptoms

Question 9

Ann Arbor staging

Answer 9

Stage I: single lymph node region or localized involvement of single extra lymphatic organ or site (A: no B sx, B: B sx)

Stage II: 2 or more lymph node regions on same side of diaphragm or localized involvement of single assd extra lymphatic organ or site and its regional lymph nodes with/without involvement of other lymph node regions on same side of diaphragm

Stage III: involvement of lymph node regions on both sides of the diaphragm +/- localized involvement of an associated extra lymphatic organ or site, spleen, or both

Stage IV: disseminated involvement of one or more extra lymphatic organs with/without associated lymph node involvement or isolated extra lymphatic organ involvement with distant nodal involvement

Question 10

Morphology classical Hodgkin lymphoma

Answer 10

H/RS cells greatly outnumbered by background of non-neoplastic T cells and variable number of mixed inflammatory cells

Question 11

Immunophenotype of classical Hodgkin lymphoma

Answer 11

positive: CD30, CD15, PAX-5 (dimmer than background B cells), fascia (strong cytoplasmic staining), MUM1
negative: CD45, CD20 (30% of cases weakly pos), Oct2, Bob1

flow may show increased CD4:CD8

Question 12

Prognosis of classical Hodgkin

Answer 12

pathologic stage and the presence of B sx have greater prognostic value than histologic subtype

Question 13

Chemotherapy regimens for classical Hodgkin lymphoma

Answer 13

ABVD (most common)