Hodgkin Lymphoma Flashcards
1
Q
What are the divisions of Hodgkin Lymphoma ?
A
- Nodular Lymphocyte Predominant Hodgkin Lymphoma
- Classical Hodgkin Lymphoma
- Nodular sclerosis
- Mixed cellularity
- Lymphocyte rich
- Lymphocyte depleted
2
Q
What is the clinical presentation of
Nodular lymphocyte predominant HL ?
A
- usually younger men (age ~30)
- B symptoms are uncommon
- Beter survival than CHL
- usually cervical and axillary lymph nodes
- medistinum is rarely involved
3
Q
What is the microscopic morphology of
Nodular lymphocyte predominant HL ?
A
- mixed cell infiltrate outnumbers the large neoplastic cells
- must have a vaguely nodular appearance at low power
- moth eaten nodule appearance
- absent reactive germinal centers
- granulomas may be present
- classic cell: L & H cell
- abundant cytoplasm, convoluted nucleus (popcorn cell)
- usually confined to follicular dendritic meshwork
4
Q
What stains can be used to highlight
the follicular dendritic cell meshwork ?
A
- CD21 and CD23 (looks expanded)
5
Q
What is the composition of the non-neoplastic
infiltrating cells ?
A
- predominant small infiltrating lymphocytes
- CD20+ B cells
- Wreath of T cells around the L&H cells
- CD3+
- PD1+
- CD57+
6
Q
What is the immunophenotype of
the neoplastic L&H cells ?
A
- Positive
- CD45, CD20
- surface Ig
- bcl6 and EMA
- Negative
- CD15, CD30
- OCT2, BOB1
- EBV
7
Q
What rearrangement can be seen in
L&H cells ?
A
- rearranged IgH genes with bcl6
8
Q
What is a possible precursor lesion to
Nodular Lymphocyte Predominant HL ?
A
Progressive transformation of the germinal centers
- presents in young adults, asymptomatic lymphadenopathy (cervical)
- can recur or resolve spontaneously
- Large follicles (4-5x, normal)
- hyperplastic GC, mantle zones migrate into and disrupt the GC
- each follicle is at a different stage of being affected
Note: can be associated with reactive follicular hyperplasia
