Difference between revisions of "Hodgkin lymphoma"
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'''Hodgkin [[lymphoma]]''', abbreviated '''HL''', is a haematological [[malignancy]]. If not otherwise specified, Hodgkin lymphoma generally refers to classical Hodgkin lymphoma (cHL) rather than less common [[nodular lymphocyte-predominant Hodgkin lymphoma]] (NLPHL). The latter accounts for only about 5% of the loose label of Hodgkin lymphoma<ref name=Ref_WMSP567/> and shows a sufficiently different biology and immunophenotype that is essentially a different disease (see [[nodular lymphocyte-predominant Hodgkin lymphoma|main article on NLPHL]]). The common feature is large atypical cells: Hodgkin/Reed-Sternberg cells in the case of classical Hodgkin lymphoma and "popcorn"/lymphohistiocytic/L&H cells in NLPHL. However, at least in typical cases, there are morphological and immunophenotypic differences. | |||
Classical Hodgkin lymphoma has a bi-modal distribution, afflicting young adults and with a further peak in incidence in middle-age. Fortunately, it usually has a good prognosis. | |||
Pathologists say "... it is both the easiest and hardest diagnosis to make." The reason for this is: the diagnosis depends on finding Reed-Sternberg cells (or Popcorn cells); if they are obvious the diagnosis is easy... if you can't find 'em and an alternative diagnosis is not apparent -- you wonder whether you're missing them. | Pathologists say "... it is both the easiest and hardest diagnosis to make." The reason for this is: the diagnosis depends on finding Reed-Sternberg cells (or Popcorn cells); if they are obvious the diagnosis is easy... if you can't find 'em and an alternative diagnosis is not apparent -- you wonder whether you're missing them. | ||
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*Usually good. | *Usually good. | ||
*Unlike non-Hodgkin lymphomas, it spreads in a predictable pattern; thus, staging plays an important role in determining the therapy.<ref name=PCPBoD8_315>{{Ref PCPBoD8|315}}</ref> | *Unlike non-Hodgkin lymphomas, it spreads in a predictable pattern; thus, staging plays an important role in determining the therapy.<ref name=PCPBoD8_315>{{Ref PCPBoD8|315}}</ref> | ||
*Clinically classified into early favourable, early unfavourable and late/advanced disease. | |||
== | ===Classic HL sub-types=== | ||
====Subtypes of classic HL==== | |||
There are four CHL subtypes:<ref name=Ref_WMSP567/> | |||
*Nodular | #Nodular sclerosis CHL - ~70% of CHL. | ||
#*Mixed cellular background - T cell, plasma cells, eosinophils, neutrophils and histiocytes. | |||
#*Nodular sclerosing fibrosis - thick strands fibrosis. | |||
#Mixed cellularity CHL - ~20-25% of CHL. | |||
#*Like nodular sclerosis - but no fibrosis. | |||
#*May be associated with [[HIV]] infection.<ref name=pmid20138008>{{cite journal |author=Sissolak G, Sissolak D, Jacobs P |title=Human immunodeficiency and Hodgkin lymphoma |journal=Transfus. Apher. Sci. |volume=42 |issue=2 |pages=131–9 |year=2010 |month=April |pmid=20138008 |doi=10.1016/j.transci.2010.01.008 |url=}}</ref> | |||
#Lymphocyte-rich CHL - rare. | |||
#*T lymphocytes only (no mix of cells). | |||
#Lymphocyte-depleted CHL - rare. | |||
#*May be associated with HIV infection.<ref name=pmid20138008/> | |||
Memory device: | |||
*The subtypes prevalence is in reverse alphabetical order. | |||
* | |||
==Gross== | ==Gross== | ||
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Image:Hodgkin_lymphoma_%281%29_mixed_cellulary_type.jpg | HL mixed cellularity. (WC) | Image:Hodgkin_lymphoma_%281%29_mixed_cellulary_type.jpg | HL mixed cellularity. (WC) | ||
</gallery> | </gallery> | ||
===DDx both CHL & NLPHL=== | ===DDx both CHL & NLPHL=== | ||
*CHL/NLPHL. | *CHL/NLPHL. |