Hodgkin Lymphoma Flashcards
Classic Hodgkin Lymphoma (CHL):
- Incidence
- Characteristic cell
- Clinical presentation (2)
- Bimodal; 15-35/>50 y/o
- Reed-Sternberg cells (+ variants)
- Localized lymphadenopathy
- “B” symptoms
What is true regarding Lacunar Cells?
Formal fixation induced retraction artifact
Classic Hodgkin Lymphoma (CHL) - Immunophenotype:
-Negative for (5)
- CD20*
- CD45
- bcl-6
- ALK
- EMA
*10-20% of cases express CD20
_______ Nodular Sclerosis CHL is an aggressive form of CHL, that often presents at a High stage with _______, composed of sheets of RS cells and RS variants; may undergo focal _______.
Syncytial Nodular Sclerosis CHL is an aggressive form of CHL, that often presents at a high stage with bulky mediastinal disease, composed of sheets of RS cells and RS variants; may undergo focal necrosis.
What CHL subtype is the 2nd MC?
Mixed Cellularity (MC) - 25%
Classic Hodgkin Lymphoma (CHL) - Immunophenotype:
-Positive for (6)
- CD15
- CD30
- fascin
- IRF4/MUM1
- PAX5 (weak)
- EBV Ags (LMP-1/EBER1/2)
Nodular Lymphocyte Predominant Hodgkin Lymphoma (NLPHL) - Morphology:
- Architecture
- Characteristic cell
- Precursor lesion
- Nodular proliferation
- L&H cells *(RS cells - Rare/Absent)
- Progressive transformation of GCs
Classic Hodgkin Lymphoma (CHL) - BM Involvement:
- Definition
- Overall %
- Highest in what subtype/population (2)
Atypical mononuclear CD30+ cell in appropriate background
- 10% overall
- Lymphocyte Depleted (50%)/HIV-associated (60%)
In CHL, the background lymphocytes are predominantly what?
T-cells
Lymphocyte Rich (LR) CHL - Immunophenotype: -Negative for (5)
- CD20*
- CD45
- bcl-6
- ALK
- EMA
*10-20% of cases express CD20
What are L&H cells?
Lymphocytic and Histiocytic cells
- “Popcorn cells”
- Large, vesicular convoluted nucleus
All of the CHL subtypes spread via contiguous lymphatic sites, except for what?
Lymphocyte Depleted CHL
-Noncontiguous spread
L&H cells - Immunophenotype:
-Positive for (5)
L&H cells - Positive IHC:
- CD20
- CD45
- bcl-6
- EMA
- surface Ig (sIg)
Mixed Cellularity (MC) CHL: -Histology
Diffuse proliferation of lymphocytes, eosinophils, histiocytes and plasma cells
-varying numbers of RS cells and mononuclear Hodgkin cells
What lymph nodes are most commonly involved in CHL?
-2nd?
Cervical
-Mediastinum (2nd)
Lymphocyte Rich (LR) CHL - Immunophenotype: -Positive for (6)
- CD15
- CD30
- fascin
- IRF4/MUM1
- PAX5 (weak)
- EBV Ags (LMP-1/EBER1/2)
Mixed Cellularity (MC) CHL: -Population (2)
- Underdeveloped countries
- HIV infected patients
Nodular Sclerosis (NS) CHL:
- Location
- Architecture
- Characteristic Cells (2)
- Mediastinum (MC)
- Nodular proliferation w/ bands of sclerosis
- RS Cells/Lacunar Cells
What is the most common subtype of CHL?
-Percentage?
Nodular Sclerosis (70%)
Nodular Lymphocyte Predominant Hodgkin Lymphoma (NLPHL): (3)
- Meshwork of Follicular Dendritic cells (CD21+/CD23+)
- Predominance of CD20+ B cells
- Wreath of CD3+/CD57+ T cells
What is the most common site for Lymphocyte Depleted (LD) CHL?
Retroperitoneum
CHL Subtypes - %EBV+
- Nodular Sclerosis
- Mixed Cellularity
- Lymphocyte Rich
- Lymphocyte Depleted
CHL Subtypes - %EBV+
- NS (25%)
- MC (75%)
- LR (50%)
- LD (50%)
Lymphocyte Depleted (LD) CHL:
- Incidence
- Presentation/behavior
- RS cell types (#/hpf)
- Incidence increases with Age
- Higher stage/Aggressive
- Classic RS cells/Pleomorphic (>15 hpf)
Lymphocyte Rich (LR) CHL is similar to what? -How is it differentiated?
Nodular Lymphocyte Predominant HL (NLPHL)
-Immunophenotype same as CHL
L&H cells - Immunophenotype:
-Negative for for (5)
L&H cells - Negative IHC:
- CD15
- CD30
- OCT2
- BOB1
- EBV
