Hodgkin lymphoma Flashcards
HL vs NHL
Lymph node involvement
- HL
- Single, axial group of nodes (cervical, mediastinal, para-aortic)
- NHL
- Multiple, peripheral nodes
Memory aid:
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HL is SAC
- Single
- Axial
- Contiguous
HL vs NHL
Spread
- HL
- Contiguous
- NHL
- Non-contiguous
Memory aid:
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HL is SAC
- Single
- Axial
- Contiguous
HL vs NHL
Mesenteric nodes and Waldeyer ring involvement
- HL
- Rare
- NHL
- Common
HL vs NHL
Extranodal involvement
- HL
- Rare
- NHL
- Common
Subtypes
- Nodular sclerosis (NS)
- Mixed cellularity (MC)
- Lymphocyte rich (LR)
- Lymphocyte depleted (LD)
- Lymphocyte predominant (LP)
Morphologic pearls
- Reactive T-cells with fibrous bands forming nodules
- Mixed leukocytic infiltrate without fibrous nodules
- Rich reactive T-cell infiltrate
- Rare reactive lymphocytes
- Reactive B cells; lymphohistiocytic “popcorn” RS cells
- Nodular sclerosis (NS)
- Mixed cellularity (MC)
- Lymphocyte rich (LR)
- Lymphocyte depleted (LD)
- Lymphocyte predominant (LP)
- Nodular sclerosis (NS)
- T cell; Fibrous bands forming nodules
- Mixed cellularity (MC)
- Mixed; ⊝ fibrous bands
- Lymphocyte rich (LR)
- Rich T cell
- Lymphocyte depleted (LD)
- Rare T cell
- Lymphocyte predominant (LP)
- B cell; P is to P for popcorn
Association with EBV
- Nodular sclerosis (NS)
- Mixed cellularity (MC)
- Lymphocyte rich (LR)
- Lymphocyte depleted (LD)
- Lymphocyte predominant (LP)
- Nodular sclerosis (NS)
- None
- Mixed cellularity (MC)
- 70%
- Lymphocyte rich (LR)
- 40%
- Lymphocyte depleted (LD)
- Most ⊕
- Lymphocyte predominant (LP)
- None
Immunophenotype
All as CD15 and CD30 positive except LP which is negative but CD20 positive
Large, abnormal lymphocytes that may contain more than one nucleus; each with nucleolus (Owl-eye nucleus)
RS cells
23/F, Filipino, with long-standing solitary left lateral neck mass, with fever and night sweats. PPD is positive.
- LN biopsy: mixed infiltrate of inflammatory cells with large cells with multiple nuclei, each of which has a nucleolus (“Owl-eye” nuclei); fibrous nodules are not observed
- IHC: Large cells are positive for CD15 and CD30
What is the diagnosis?
Mixed cellularity HL
Keywords:
- Owl-eye nucleus
- fibrous nodules are not observed
- CD15 and CD30-positive
23/F, Filipino, with long-standing solitary left lateral neck mass, with fever and night sweats. PPD is positive. If at least one fibrous nodule is observed, with scattered RS cells, and no observable necrosis, what would be the histologic diagnosis?
Nodular sclerosis HL (Grade I)
23/F, Filipino, with long-standing solitary left lateral neck mass, with fever and night sweats. PPD is positive. If histology showed scant lymphocytic infiltrate with predominance of large, pleomorphic cells; some of which look like RS cells, and IHC: CD30, PAX5 (+), ALK, CD45(-), what is the histologic diagnosis?
Lymphocyte-depleted HL
