Work Up

Question 1

What are the two major types of HL?

Answer 1

1. Nodular lymphocyte predominant HL

2. Classical HL

Question 2

What are the classical subtypes of HL? What are the percentages of each?

Answer 2

1. Lymphocyte rich (10%)
2. Lymphocyte depleted (10%)
3. Mixed cellularity (30%)
4. Nodular sclerosing (60%)

Question 3

What cell is the pathognemonic for HL?

Answer 3

1. Reed-sternberg cell

Question 4

What markers are present in classical HL? CD15, CD20, CD30?

Answer 4

1. C15 +
2. CD20 -
3. CD30 +
4. CD 45
5. CD79a

Question 5

What histologic features are present in nodular sclerosing HL?

Answer 5

1. RS cells
2. sclerotic bands
3. Lymphocytes

Question 6

What histologic features are present in mixed cellularity HL?

Answer 6

1. RS cells

2. Lymphocytes

Question 7

What are the most common symptoms associated with HL?

Answer 7

1. Nontender adenopathy
   a) Neck or supraclavicular 60-80%
   b) Axilla 10-20%
   c) Inguinal-femoral 20-30%
2. Asymptomatic bulky mass seen on CXR
3. B-symptoms
4. Pruritis
5. Pain with alcohol consumption

Question 8

What type of biopsy is needed for diagnosis of HL?

Answer 8

1. Excisional lymph node biopsy

Question 9

What labs are needed for patients with HL?

Answer 9

1. CBC
2. BMP
3. LFTs including alkaline phosphatase
4. ESR
5. Pregnancy test for women of childbearing age

Question 10

What imaging studies are needed for HL?

Answer 10

1. PET/CT scan
2. Diagnostic CT of the neck, chest, abdomen and pelvis
3. CXR

Question 11

What markers are positive with nodular lymphocyte predominant hodgkin lymphoma? CD15, CD30, CD20, CD45, CD79a?

Answer 11

1. CD15 -
2. CD30 -
3. CD20+
4. CD45+
5. CD79a +

Question 12

When is a BM biopsy indicated

Answer 12

Stage III/IV or B symptoms