Hodgkins Lymphoma Flashcards
generally occurs at multiple nodal sites and its spread to other lymphoid or extranodal sites is random
non‐Hodgkin Lymphoma (NHL)
stage: constitutional symptoms of fever, night sweats, weight loss
B
CD15 and CD30 negative
Lymphocyte predominant
usually no fevers night sweats
stage I or II
Nodular sclerosis and lymphocyte predominant
generally will arise in a single lymph node chain and will spread to adjacent sites in a contiguous pattern
Hodgkin Lymphoma (HL)
The lacunar cells express (1)
CD15, CD30 and PAX5 a pan B‐cell marker; nodular sclerosis
a variant of the Reed‐Sternberg cell which shows a large clear space surrounding the nucleus
lacunar cell; refers to nodular sclerosis
CD15, CD30 and PAX5 a pan B‐cell marker
lacunar cells; nodular sclerosis
also seen in mixed cellularity, lymphocyte rich and lymphocyte depletion
constitutional B symptoms - weight loss, night sweats, fever
Mixed cellularity and lymphocyte depletion stage III or IV
promotes survival and proliferation of lymphocytes along with survival of germinal B‐cells that would normally be destined to undergo apoptosis but instead produce Reed‐Sternberg cells
NF‐Κb activation
stage: one side of diaphragm
stage II
shows characteristic nodules surrounded by bands of collagenous tissue and containing mixtures of lymphoid cells, inflammatory cells and lacunar cells
nodular sclerosis
It is interesting to note that (1) in (2) have striking resemblance to Reed‐Sternberg cells again suggesting the role of (3) in the pathogenesis of HL
- EBV infected B‐cells 2. infectious mononucleosis 3. EBV
older patients and in HIV+ patients of any age
Lymphocyte depleted
(1) has also been shown to be effective in treatment with much less toxicity
- Anti CD30
only rarely shows Reed‐Sternberg cells
lymphocyte predominant
typical B‐cell markers CD20 and BCL6
Lymphocyte predominant
(1) is a significant part of the pathogenesis in HL. It is believed to occur from (2)
- NF‐Κb activation( a transcription factor) 2. EBV infection
Reed‐Stern berg cells are easily found and they are set in a rich inflammatory background of lymphocytes, plasma cells and numerous eosinophils
mixed cellularity
Fever, night sweats, constitutional B symptoms
mixed cellularity
How to diagnosis HL
Physical exam for lymph nodes
CT scan to stage disease
bone marrow biospy
Liver, spleen and bone marrow involvement may also occur
nodular sclerosis
features a multilobed nucleus resembling a popcorn kernel and is called a “popcorn cell”
lymphocyte predominant
stage: single lymph node region
stage I
stage: disseminated
IV
stage: both sides of diaphragm
stage III
may transform to DLBCL
Lymphocyte predominant
Nodular infiltrate lymphocytes and macrophages
Lymphocyte predominant
treatment for low stage disease
radiation therapy
stage: asymptomatic
A
presents usually as a mass in the cervical, supraclavicular or commonly the mediastinal area in young adolescents
Nodular Sclerosis type HL
Stereotypic spread of HL
nodal –> splenic –> bone marrow
can develop second malignancies of lung, breast cancer or even melanoma
radiation therapy for low stage disease
germinal center or post germinal center BCells in origin
Reed‐Sternberg cell
second malignancies such as Acute Myeloid Leukemia
chemotherapy for advanced Stage III or Stage IV disease
Reed‐Sternberg cell
Hodgkin Lymphoma (HL) cell with owl eye nucleus
Most of the tumor will consist of mixtures of inflammatory cells such as (1) in Hodgkin Lymphoma (HL)
- lymphocytes, plasma cells and frequently numerous eosinophils
