HODGKIN

LYMPHOMA

Classifications

• 1%

Hodgkin lymphoma

• 1% of all cancers• Arises in lymph nodes

– (tons., Wald., EXN rare)

• Spreads predictably• characteristically to the anatomically

contiguous nodes• LN – spleen – liver – BM

• Staging: prognosis, choice of therapy

Patients

• Average: 32 years; slight male predominance• (NS: M=F)

• Curable in many cases• Lon-term survivors of chemo- and

radiotherapy:• Risk of developing second cancers• MDS, AML, lung cancer, breast cancer

HODGKIN LYMPHOMA WHO 2008

CLASSICAL (95%)

NODULAR LYMPHOCYTE PREDOMINANT(nodular paragranuloma, 5%)

DIFFER IN: TUMOUR CELLS

BACKGROUND

CLINICAL FEATURES

CLASSICAL HL

FEATURES COMMON TUMOUR CELLS

DIFFERENT BACKGROUND ARCHITECTURE

CLINICAL, EPIDEMIOLOGY EBV

SUBTYPESNODULAR SCLEROSISMIXED CELLULARITYLYMPHOCYTE RICHLYMPHOCYTE DEPLETION

TUMOUR CELLS OF CLASSICAL HLDiagnosticonly RS! Hodgkin cell

eggs in the basket

CD30+,CD15+B-markers, EBV

mummy lacunar

Classical HL

NODULAR SCLEROSIS70% CHL; 28 ys; M=Fstage II, mediastinum 40% B-symptoms

MIXED CELLULARITY

grade I and II

20% CHL; 37 ys; 70% Mstage III-IVperipheral lymph nodesspleen, bone marrowB-sympt., EBV commonHIV

LYMPHOCYTE RICH

LYMPHOCYTE DEPLETION

Classical HL

5% CHL; older; 70% Mstage I-IIperipheral lymph nodesB-sympt. rare, but relapses

<5% CHL; 37ys; 75% MadvancedB-symptoms commonpoor, HIV (EBV)

Nodular lymphocyte predominance HL

Nodular/diffuse pattern

L&H; LP = popcorn cells

Background

FDC meshworks

nonneoplastic lymphocytes

Very favourable prognosis

CD20

Reed-Sternberg cell:

communication with other cell types

Hodgkin lymphoma – Ann Arbor staging

I, IIabove

diaphragm

belowIII, IV

•Pruritus, anorexia; B sympt. correlate with stage