Hodgkin lymphoma

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Hodgkin lymphoma, abbreviated HL, is a malignancy that afflicts people in the prime of their life. 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; 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.

Clinical

Symptoms:[1]

  • "B symptoms":[2] fever, night sweats, weight loss.
  • Infections (due to immune dysfunction).

Diagnosis:

  • HL cannot be diagnosed with standard flow cytometry (FC) - but has been diagnosed with specialized FC.[3]

Hodgkin lymphoma subtypes

Types:[1]

  • Classical HL (CHL) - ~95% of HL.
  • Nodular lymphocyte-predominant HL (NLPHL) - ~5% of HL.

Classic HL

  • Four types of classic HL (see below).

NLPHL

  • AKA lympho-histiocytic variant.
  • Abbreviated NLPHL.
  • Different IHC and morphologic appearance than classic HL.

Microscopic

By definition, HL has Reed-Sternberg cells (RSCs).

Classical HL

Features (classic HL):

  • Reed-Sternberg cell.
    • Large binucleated cell.
    • Macronucleolus - approximately the size of a RBC (~8 micrometers).
    • Well-defined cell border.

Images (classic HL):

Subtypes

There are four CHL subtypes:[1]

  1. Nodular sclerosis CHL - ~70% of CHL.
    • Mixed cellular background - T cell, plasma cells, eosinophils, neutrophils and histiocytes.
    • Nodular sclerosing fibrosis - thick strands fibrosis.
  2. Mixed cellularity CHL - ~20-25% of CHL.
    • Like nodular sclerosis - but no fibrosis.
  3. Lymphocyte-rich CHL - rare.
    • T lymphocytes only (no mix of cells).
  4. Lymphocyte-depleted CHL - rare.
    • Assoc. with HIV infection.

Memory device:

  • The subtypes prevalence is in reverse alphabetical order.

Nodular lymphocyte-predominant HL

Features (nodular lymphocyte-predominant Hodgkin's lymphoma):

  • Lymphocytic & histiocytic cell (L&H cell)[4] - variant of RSC:
    • Cells (relatively) small (compared to classic RSCs).
    • Lobulated nucleus - key feature.
    • Small nucleoli.

Image (NLPHL):

IHC

Abbreviated panel:[5]

  • CD30 Reed-Sternberg cells (RSCs) +ve ~98%
  • CD15 Reed-Sternberg cells +ve ~80%, stains neutrophils.
  • CD45 often negative in RSCs.
  • CD20 may stain RSCs.
  • PAX5 +ve.[6]

Additional - for completeness:

  • CD3 (T lymphocytes)

NLPHL IHC differs from the classical HL:[6]

  • LCA +ve.
  • CD20 +ve.
  • CD10 +ve.
  • Bcl-6 +ve.
  • EMA +ve.
  • CD30 -ve
  • CD15 -ve.

"UHN panel"

Antibody NLPHL CHL
CD45 +ve -ve
CD20 +ve -ve
BCL6
MUM1[7] -ve
CD30 -ve +ve (most sensitive).
CD15 -ve +ve
CD21 networks present no networks
CD23 networks present no networks
OCT-2 +ve -ve
PAX5 +ve +ve (proves B cell linage)
CD3 usu. < benign B cell usu. > benign B cell component
CD57 rosettes around malign. cells -
EBER -ve +ve/-ve
EMA +ve/-ve -ve
4 unstained

See also

References

  1. 1.0 1.1 1.2 Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 567. ISBN 978-0781765275.
  2. URL: http://lymphoma.about.com/od/symptoms/f/bsymptoms.htm. Accessed on: 11 August 2010.
  3. Fromm JR, Thomas A, Wood BL (March 2009). "Flow cytometry can diagnose classical hodgkin lymphoma in lymph nodes with high sensitivity and specificity". Am. J. Clin. Pathol. 131 (3): 322–32. doi:10.1309/AJCPW3UN9DYLDSPB. PMID 19228638.
  4. PMID: 9499174
  5. Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 568. ISBN 978-0781765275.
  6. 6.0 6.1 Lefkowitch, Jay H. (2006). Anatomic Pathology Board Review (1st ed.). Saunders. pp. 683. ISBN 978-1416025887.
  7. URL: http://www.ncbi.nlm.nih.gov/omim/601900. Accessed on: 10 August 2010.