Hodgkins Lymphoma

Question 1

What are the two distinct entities into which the WHO classification puts Hodgkin Lymphoma (HL)?

Answer 1

Classical HL and Nodular lymphocyte-predominant HL

These entities have different immunophenotype, natural history, and response to therapy.

Question 2

What are the key characteristics of Classical Hodgkin Lymphoma (HL)?

Answer 2

Large mononuclear Hodgkin cells or binucleate/multinuclear Reed-Sternberg cells; CD30+, CD3−, CD15+, CD20−, CD45−, CD75−, CD79a−

These cells make up only 1-2% of the cellularity of the lymph node.

Question 3

What are the four histological subtypes of Classical Hodgkin Lymphoma (HL)?

Answer 3

Nodular sclerosing HL, Mixed cellularity HL, Lymphocyte depleted HL, Lymphocyte rich classical HL

Each subtype has distinct histological features.

Question 4

What is the Reed-Sternberg (RS) Cell?

Answer 4

A giant cell with two nuclei or two nuclear lobes; prominent eosinophilic nucleolus surrounded by a clear zone

Known as the ‘owl-eye’ effect.

Question 5

What are the variants of the Reed-Sternberg Cells?

Answer 5

Lacunar Cell Variant, Lymphocytic and Histiocytic (L&H) variant, Pleomorphic Cell variant

These variants exhibit different morphological characteristics.

Question 6

What are the risk factors associated with Hodgkin Lymphoma?

Answer 6

• Familial history (identical twins, siblings of young adults)
• Epstein-Barr Virus (EBV) infection
• HIV infection

EBV is found in 26-50% of cases, especially mixed cellularity HL.

Question 7

What is the annual incidence of Hodgkin Lymphoma in Europe and the USA?

Answer 7

73 per 100,000

HL represents 1% of cancer registrations annually.

Question 8

What is the bimodal age incidence of Hodgkin Lymphoma?

Answer 8

Major peak between 20-29 years and a second smaller peak at 60 years

Median age is 35, with >90% of cases occurring in ages 16-65.

Question 9

What histological subtype of Hodgkin Lymphoma is most common in young adults?

Answer 9

Nodular sclerosing HL (NSHL)

Over 75% of NS cases are in individuals <40 years.

Question 10

What are the clinical features of Hodgkin Lymphoma?

Answer 10

Asymptomatic lymphadenopathy, spleen involvement in 73%, may present with bulky mediastinal lymphadenopathy

Lymphadenopathy may wax and wane.

Question 11

What is the initial mode of spread for Hodgkin Lymphoma?

Answer 11

Predictably to contiguous nodal chains

Waldeyer’s ring involvement is rare.

Question 12

What investigations are necessary for diagnosing Hodgkin Lymphoma?

Answer 12

• Clinical history
• Lymph node excision biopsy
• FBC
• ESR
• Chest X-Ray

HIV serology is recommended in all patients.

Question 13

What is the standard treatment for early-stage Hodgkin Lymphoma?

Answer 13

Combination Chemotherapy (ABVD ± IFRT)

ABVD includes Adriamycin, Bleomycin, Vinblastine, and Dacarbazine.

Question 14

What is the International Prognostic Score used for in Hodgkin Lymphoma?

Answer 14

To determine treatment strategy for advanced stages of HL (III/IV)

Factors include serum albumin, hemoglobin, gender, stage, age, WBC count, and lymphopenia.

Question 15

True or False: Extranodal spread and bone marrow involvement are common in Hodgkin Lymphoma.

Answer 15

False

Extranodal spread is rare and usually accompanied by generalized lymphadenopathy.

Question 16

Fill in the blank: Hodgkin lymphoma was first described by _______.

Answer 16

Thomas Hodgkin

This occurred in 1832.

Question 17

What type of lymphoma arises from mature B lymphocytes at the germinal center stage?

Answer 17

Hodgkin Lymphoma (HL)

Non-Hodgkin Lymphoma (NHL) arises from B or T lymphocytes.