Hodgkin lymphoma

Hodgkin lymphoma or Hodgkin disease (HD) is a type of lymphoma and accounts for ~1% of all cancers. HD spreads contiguously and predictably along lymphatic pathways and is curable in ~90% of cases, depending on its stage and sub-type.

There is a bimodal distribution in the age of affected patients, with peaks in young adults (15-34 years) and older patients (>55 years).

Typical presention is with painless lymphadenopathy. Systemic symptoms (B symptoms) such as night sweats and weight loss may be present.

An uncommon presentation described in Hodgkin disease is pain in involved organs following alcohol consumption.

The disease is characterised by the presence of Reed-Sternberg cells (considered to be a type of B cell). These cells however only occupy a very small proportion (<5%) of the overall cell population of the affected lymph node. Contiguous spread is another feature. EBV infection is present in 40-80% depending on subtype 4.

Subtypes

There are five recognised histological sub types.

Classical

Positive for CD15/CD30 and negative for CD20/CD45/EMA:

  • nodular sclerosing: ≈70%
  • mixed cellularity: ≈25%
  • lymphocyte rich: 5%
  • lymphocyte depleted: <5%
Non classical

Positive for CD 19, 20, 22, 79a/EMA and negative for CD15/CD30:

  • nodular lymphocyte predominant (nodular paragranuloma)
Classification

For classification of lymphomas see WHO classsification of neoplasms of lymphoid tissues.

Location
Nodal disease

Hodgkin's disease is usually almost entirely confined to the lymph nodes.

Extranodal disease

Extranodal HD although uncommon may be found in any organ system, either as a primary manifestation or as dissemination of systemic disease. This distinction is important, as disseminated disease carries a poorer prognosis. Extranodal disease may occur via invasion of adjacent tissue or via haematogenous spread.

Organ specific involvement:

Staging

In contrast to other types of lymphoma, Hodgkin disease is usually characterised by a systematic nodal spread pattern making accurate staging important.

See main article: Hodgkin lymphoma staging.

Prognosis depends on stage as well as several other factors such as age, serological markers (ESR), presence of B symptoms, and histological tumour subtype:

  • nodular lymphocyte predominant: best prognosis
  • lymphocyte depleted: worse prognosis

Treatment is dependant on the stage of disease:

  • stage IIa and below: localised radiotherapy
  • stage IIb and above: chemotherapy +/- radiotherapy to sites of large tumour bulk

Lymphoma
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Article Information

rID: 1458
Section: Pathology
Synonyms or Alternate Spellings:
  • Hodgkin disease
  • Hodgkin lymphoma
  • Hodgkin disease

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Cases and Figures

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    Hodgkin lymphoma
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    Figure 1: gross pathology
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    Case 1
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    Hodgkin lymphoma
    Case 2
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    Case 3: with abdominal lymphadenopathy
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    Case 4: large mediastinal mass: Hodgkin's lymphoma
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     Case 5
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    Case 6
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    Case 7: nodular sclerosing: involving axilla
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    CT thorax
    Case 8
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    Case 9
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