Hodgkin Lymphoma Pathology Flashcards
Hodgkin lymphoma is a malignant neoplasm → proliferation of _____
eosinophils, fibrosis
(lymph nodes → spreads to BM, spleen, liver)
HL is the MC _______ Lymphoma
Primary Mediastinal
Reed-sternberg cells are diagnostic of Hodgkin’s lymphoma. What are they?
Malignant cell of HL: R-S or S-R variant cells
(use immunophenotypic markers to differentiate)
Population of Hodgkin Lymphoma compared to Non-Hodgkins (malignant)
- HL: bimodal
- NHL: older adult (>50)
_____ or immunodeficiency are risk factors for HL.
EBV infection (mono)
RS cell is a B-cell w/more than one _____
nucleus w/eosinophilic nucleoli
(owl eyes; they can be found in other disorders also)
Reed-sternberg cells with CD30+, CD15+, Pax5 +, is diagnostic of _____
HL
(CD45(-), Fascin +)
HL typically starts in the _______.
peripheral lymph nodes
Slow enlargement of lymph nodes in the neck of supraclavicular area, _____ fevers (waxes and wanes), _____ are symptoms of HL.
- Pel-ebstein
- drenching night sweats
In addition to B-symptoms, unique sx of HL include _______.
- pruritus
- adenodynia d/t alcohol ingestion
(also hepatosplenomegaly)
Why does HL present with a normocytic-normochromic anemia?
- metastasis to BM → pancytopenia
- cytokines disrupt BM
(elevated cytokines can also have a paracrine effect → hypercalcemia)
Dx tests for HL
- CT scan
- lymph node bx
- BM bx
_____(2 tests) are necessary for staging hodgkin’s
- CT scan w/contrast
- 3D PET-CT hybrid using positron-emitting F-18 fluorodeoxyglucose (FDG)
(glycolysis increases due to Warburg effect)
Warburg effect
“degenerate cellular energetics”: shift in cellular metabolism to glycolysis → lactate generation. This feeds the malignant cells more carbon to build themselves
(regardless of O2 available)
Ann Arbor System for staging HL
- single node or adjacent group of nodes
- multiple nodes (same side of diaphragm; Stage 2 Bulky if bulk >10cm)
- both sides of diaphragm
- extranodal sites (A: absence of B sx; B: presence of B sx)
After staging is complete, you can _____
stratify risk and give your patient a prognosis
HL has an increase in ______type symptoms (3)
- neurologic (ataxia, memory loss, neuropathy)
- dermopathies (Erythema nodosum, ichthyosis)
- nephrotic syndrome
cure rate for HL
80% at 5 years w/aggressive therapy
(one of the most treatable cancers)
Secondary Malignancy is a possible risk of the aggressive chemotherapy that is required to cure HL. Which malignancies are they?
- NHL
- Sarcoma
- AML
- Carcinoma
(there are permanent changes to the genetics)
Which 3 HL subtypes do NOT include EBV as a risk factor?
- Nodular
- Lymphocyte-rich
- Lymphocyte-predominant
All of the HL subtypes are CD15+, CD30+, except for _______.
lymphocyte predominance (CD20+, CD15+)
Which 2 subtypes of HL present w/T-cell, eosinophil, MF, and plasma cell infiltrates background and RS cells (2)?
- Nodular
- Mixed cellularity
MC neoplasm of the anterior mediastinum
thymoma
(50% manifest sx of Myasthenia Gravis)
lobular nodules of nodular sclerosis HL are from _____
dense collagen bands surrounding malignant cells
Which HL subtype has mediastinum involvement, B-sx and is more common in women?
Nodular sclerosing
What is the 1st and 2nd MC HL subtype?
- Nodular Sclerosing
- Mixed cellularity
Which HL subtype is commonly associated w/HIV, has B-sx and a broad age group affected?
Mixed cellularity
Which HL subtype has peripheral lymphadenopathy, B-sx, and mononuclear infiltrates?
Lymphocyte-rich
Which HL subtype has a poor prognosis, involves the abdominal lymph nodes and has NO mediastinal involvement?
Lymphocyte-depleted
Which HL subtype has PAX5+, BCL6+, and “popcorn cells”?
Nodular Lymphocyte Predominance
(popcorn cells have nuclei folds that resemble popcorn)
Which HL Subtype has a follicular dendritic cell background + RS cells?
Nodular Lymphocyte Predominance
(good prognosis, cuz popcorn is delicious)
