Hodgkin Lymphomas

Question 1

Differentiate NHL from HL.

Answer 1

NHL:

• frequently extranodal and diffuse
• masses mostly composed of neoplastic lymphocytes

HL:

• single nodal and contiguous mass
• masses mostly composed of inflammatory cells and fibrosis
• masses precipitated by Reed-Sternberg cells (special type of neoplastic B cell) which release chemokines

Question 2

What are the classifications of HL?

Answer 2

• nodular sclerosis
• mixed cellularity
• lymphocyte-rich
• lymphocyte depleted
• lymphocyte predominance

Question 3

What are Reed-Sternberg cells?

Answer 3

• neoplastic B cell causing HL
• large cell with multilobed nuclei with prominent nucleoli giving “owl-eye” appearance

Question 4

What is the most common type of HL?

Answer 4

nodular sclerosis type (65-70%)

Question 5

What is the least common type of HL?

Answer 5

lymphocyte depleted

Question 6

What is the nodular sclerosis type of HL?

(infiltrate, markers)

Answer 6

• frequent lacunar RS cells
• fibrous bands forming nodules
• mixed cell infiltrate
• not associated with EBV
• “classic” RS cell markers (CD15, CD30)

Question 7

What is the mixed cellularity type of HL?

(infiltrate, markers)

Answer 7

• mononuclear variant and RS cells
• mixed cell infiltrate
• strong EBV association
• “classic” RS cell markers (CD15, CD30)

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Question 8

What is the common presentation of nodular sclerosis HL?

Answer 8

-young adults (equal amongst M/F)

-painless cervical and medistinal lymphadenopathy

-early stages and asymptomatic

Question 9

What is the prognosis of nodular sclerosis HL?

Answer 9

-excellent prognosis

Question 10

What is the common presentation of mixed cellularity HL?

Answer 10

-greater in males

-biphasic; young adults and adults older than 55

• painless lymphadenopathy
• later stages with fever, night sweats and weight loss

Question 11

What is the prognosis of mixed cellularity HL?

Answer 11

-very good prognosis

Question 12

What is the lymphocyte rich type of HL?

(infiltrate, markers)

Answer 12

• mononuclear and RS cells
• primarily lymphocyte inflitrate
• partial association with EBV
• “classic” RS cell markers (CD15, CD30)

Question 13

What is the common presentation of lymphocyte rich HL?

Answer 13

• older adults
• more frequent in men
• uncommon

Question 14

What is the prognosis of lymphocyte rich HL?

Answer 14

-best prognosis

Question 15

What is the lymphocyte depleted type of HL?

(infiltrate, markers)

Answer 15

• reticular variant RS cells
• frequent RS cells, scant lymphocytes
• EBV⁺
• “classic” RS cell markers (CD15, CD30)

Question 16

What is the common presentation of lymphocyte depleted HL?

Answer 16

• older men -or- HIV infected any age
• painless lymphadenopathy
• later stages with fever, night sweats and weight loss

Question 17

What is the prognosis of lymphocyte depleted HL?

Answer 17

-compartively worst prognosis but still good

Question 18

What is the lymphocyte predominance type of HL?

(infiltrate, markers)

Answer 18

• abnormal L&H RS variant; multilobed nucleus “popcorn cell”
• DC and B cell infiltate (absent eosinophils and plasma cells)
• not associated with EBV
• atypical RS cell markers (BCL6 and CD20; no CD15 and CD30)

Question 19

What is the common presentation of lymphocyte predominance HL?

Answer 19

• young males (*nodular was young but equal)
• painless cervical and medistinal lymphadenopathy
• early stages and asymptomatic

*otherwise very similar presentation to nodular

Question 20

What is the prognosis of lymphocyte pedominance HL?

Answer 20

• excellent prognosis
• higher recurrance than others