Hodgkin Lymphoma Flashcards
Hodgkin Lymphoma Subtypes
Classical Hodgkin lymphoma (95%)
- Nodular sclerosis classical (65-70%)
- Mixed cellularity classical (20-25%)
- Lymphocyte-rich classical (<5%)
- Lymphocyte depleted classical (<5%)
**Nodular lymphocyte predominance Hodgkin lymphoma (5%)
Molecular Pathogenesis
Germinal center or post germinal center B-cell with V(D)J recombination and somatic hypermutation
Aneuploid
Activated transcription factor NF-κβ
Lymphocyte predominance subtype
- morphology and immunophenotype
RS cells CD20+, CD15-, C30-; EBV-, BCL6+
Frequent L&H (popcorn cell
young males with cervical or axillary lymphadenopathy
what is the MOST COMMON FORM OF HODGKIN LYMPHOMA IN PATIENTS>50
Mixed cellularity
Most common subtype of hodgkin lymphoma?
Nodular sclerosis
Classical Hodgkin Lymphoma- immunophenotyping
CD30+, CD15+, CD20-, CD45-, PAX5+, +/- EBV
Reed-Sternberg cell types seen in all Hodgkin subtypes except nodular lymphocyte predominant Hodgkin lymphoma
what do reed sternberg cells look like?
2 eyes staring at you.
sometimes mononuclear variant
What cells do we see in nodular sclerosis subtype?
Lacunar variant seen in nodular sclerosis subtype
lacunar– spaces
Hodgkin disease, nodular lymphocyte-predominance
immunohistochemistry
CD20+, CD 45+, BCL6+, CD15-, CD30-, EBV-
Lymphohistiocytic variants (L&H; “popcorn” cells) in nodular lymphocyte predominant Hodgkin lympohoma
Clinical Features of Hodgkin Lymphoma- Classical
Lymphadenopathy at first
Classical Hodgkin lymphoma
- Cervical, mediastinal, axillary, para-aortic
- Bimodal age distribution
Clinical Features of Hodgkin Lymphoma- Nodular lymphhocyte predominance
Nodular lymphocyte predominance Hodgkin lymphoma
- Cervical, axillary, inguinal [not involving mediastinum]
- Young males under 35 years
Symptoms that develop later in both types of hodgkin lymphoma
Later develop involvement of spleen, liver, marrow, etc.
- B symptoms (= constitutional symptoms)
- — Fever, drenching night sweats, weight loss
Lymph node, itching, abdominal pain or vomiting with ethanol consumption
Cutaneous anergy (suppressed TH1 immune responses)
Post-treatment develop myelodysplasia, leukemias, non-Hodgkin lymphoma, lung cancer, gastric cancer, sarcoma and melanoma
Clinical Staging of Hodgkin
and Non-Hodgkin Lymphomas
I- involvement of a single lymph node region or a single extra-lymphatic organ or site (IE). E means extra-lymphatic. S means spleen.
II- Involvement of two or more lymph node regions on the same side ofthe diaphragm alone or localized involvement of an extra-lymphatic organ or site.
III- involvement of lymph node regions on both sides of the diaphragm without or with localized involvement of an extra-lymphatic organ or site.
IV- Diffuse involvemet of one or more extra-lymphatic organs or sites with or without lymphatic involvement.
All stages are further divided on the bases of hte absence (A) or presence (B) of the following symptoms: unexplained fever, drenching night sweats, and/ or unexplained weight loss of greater than 10% of normal body weight.
Differences between hodgkin and non-hodgkin lymphomas.
Hodgkin:
- bimodal age (more young)(20-29 and over 70)
- mostly localized to a single axial group of nodes (cervical, mediastinal, para-aortic)
- orderly spread by contiguity
- mesenteric nodes and waldeyer ring rarely involved
- extra-nodal presentation rare
- excellent response to therapy
Non-hodgkin lymphooma:
- elderly
- more frequent involvement of multiple peripheral nodes
- noncontiguous spread
- waldeyer ring and mesenteric nodes commonly involved
- extra-nodal presentation common
- poor response to therapy
Incidence and Mortality Rates
very few deaths of hodgkin’s
non-hodgkin- incidence is going up. we’re living longer, exposed to more things. until recently, deaths going up.
