00:01
Our topic now brings us
to Hodgkin’s lymphoma.
00:05
Whenever you deal
with Hodgkin lymphoma,
you should be thinking and contrasting
non-Hodgkin’s lymphoma (NHL).
00:13
There are some general
features with Hodgkin
that do not exist with non-Hodgkin that
you need to be quite familiar with.
00:19
And that entire category of
NHL or non-Hodgkin’s lymphoma
was quite important for us.
00:27
With Hodgkin, it presents in a single
lymph node or several adjacent lymph node.
00:33
The type of spread that you find
with Hodgkin is called contiguous.
00:36
Non-Hodgkin’s lymphoma,
it will be non-contiguous, more common.
00:42
In Hodgkin, it's confined to lymph
node with little extranodal component.
00:47
Non-Hodgkin lymphoma,
you’d find there to be extranodal
involvement to be quite common.
00:54
In Hodgkin,
spreads in a contiguous fashion.
00:58
What does that mean?
From one node to
adjacent lymph node.
01:01
Maybe from the mediastinum
to the cervical lymph node.
01:04
However with non-Hodgkin,
it will be non-contiguous.
01:09
With Hodgkin, we have absolutely
the most important point,
histologically you must find a particular
B-cell lymphoma or B-cell, excuse me.
01:18
In that particular B-cell,
I will show you patterns, morphologically,
of Reed-Sternberg cell.
01:25
In pathology,
we call this owl eyes.
01:28
And when the time is right, I’ll walk you
through different types of Reed-Sternberg.
01:33
If you do not find
Reed-Sternberg cell,
either in description
or upon histology,
you cannot diagnose your
patient with Hodgkin.
01:45
Etiologies:
Reed-Sternberg cells show evidence
of EBV infection oftentimes.
01:51
Well, I will walk you through
different types of Hodgkin,
and I will also give you what
the most common type would be.
01:57
One would be called
nodular sclerosing
and the other type
would be mixed cellular.
02:02
Our focus will be on those 2.
02:04
Your focus really should be on
nodular sclerosing as you shall see.
02:08
But there is evidence of EBV,
very much being involved with Hodgkin.
02:13
The surrounding inflammatory stroma
results from expression of cytokines.
02:17
So here from the Reed-Sternberg
cell which is technically B-cell,
you would expect B-cells to
release cytokines and perhaps TNF.
02:25
No exception here.
02:26
You have a cancer cell,
a Reed-Sternberg cell,
which is behaving like a
B-cell but it is pathological.
02:38
An important table for you to understand
your different types of Hodgkin lymphoma.
02:44
Subtype nodular sclerosis
would be the most common.
02:47
Hence,
you pay attention to this.
02:49
Now, before we move on,
where is my cancer originating from?
From the lymph node.
02:56
Anytime you see
the word lymphoma,
non-Hodgkin lymphoma
or Hodgkin lymphoma,
the origin of the cancer
will be from the lymph node.
03:05
Is there a possibility that it
might enter the circulation?
Oh, absolutely.
03:09
Absolutely, so therefore you might
have a leukemic type of picture.
03:13
Therefore, at this point,
since we’re getting close to completing
discussion of Hodgkin lymphoma
that all lymphomas will
begin/originate from the lymph node
as being cancerous
and may look leukemic.
03:29
And our discussion of leukemia will be
one in which the origin of those cancer
and leukemia would be the bone
marrow and could enter lymph node.
03:37
Keep that in mind.
03:38
The behavior could be rather
similar in presentation.
03:42
However, how it got there,
that’s important.
03:46
Now when you say sclerosing,
what is undergoing
sclerotic process?
The lymph node.
03:52
So therefore the lymph node in your
head, at this point,
really it will be in your best interest to
know what a normal lymph node looks like.
04:00
And what happens here is that the lymph
node will then undergo sclerosing.
04:03
In other words,
narrowing or scarring or in other words,
there is more or less
fibrotic type of change.
04:11
You lose the normal
architecture of the lymph node.
04:14
I will show you different
types of Reed-Sternberg cell.
04:17
At this point,
I would recommend that you memorize
lacunar and classic type of Reed-Sternberg.
04:24
Let me give you a
brief description.
04:26
Lacunar,
you would expect there to be quite a
bit of space within the cell, okay?
Wide vacuoles or enlarged
vacuoles, lacunar type.
04:36
However,
you still would have to find these
owl eyes and I will show
you those coming up.
04:41
The background here, bands of
fibrosis, fibrosis, fibrosis.
04:44
That’s where your
focus should be.
04:46
And by fibrosis, I mean the
lymph node is becoming fibrosed.
04:50
When it does, what then happens
to the actual structure?
As you would expect with
fibrosis, contracture.
04:57
And so therefore, this will then
refer to as being sclerosing.
05:00
Those are the 2 big points,
architecture in the
Reed-Sternberg and the types.
05:06
Now, the third big point
will be the clinical feature.
05:08
Most of your Hodgkin lymphoma, in fact,
will be affecting males, males, males.
05:14
Nodular sclerosing is an
exception where you will find here
that not that there are more females that
have greater preponderance over males.
05:24
it’s just the fact that
men and women are equally
at risk of developing
Hodgkin lymphoma.
05:31
Young adults, and I will talk to you
about staging in great detail I have to.
05:35
Pay attention to stage I and II.
05:37
That will make more sense
to you as I go through
a particular classification
that will be responsible for
every stage as we
go through them.
05:46
Mediastinal lymph nodes
often times are involved.
05:49
And if the lymph
nodes are involved,
understand that this is a
cancer, so therefore,
these lymph nodes
will be nontender.
05:56
I'll spend some time
with nodular sclerosing
more than I would with
any other type here.
06:01
Because it is the most common.
06:03
Once you get past this,
then you take out a few notes from the
remaining types of Hodgkin lymphoma.
06:11
We have mixed cellularity.
06:13
M – mixed cellularity,
M – mononuclear.
06:17
Use that to your advantage.
06:18
I will show you a picture
of a Reed-Sternberg cell
that will be mononuclear type.
06:23
The background here will be
mixed, mixed cellularity.
06:26
And here,
once again, we’ll get back to
the normal preponderance in men
or men being more
affected than women.
06:35
All ages here, not so much young and look
for mixed particularly in the elderly.
06:41
And that’s important.
06:43
And also association with EBV.
06:46
And then I will talk to you
about stage III and stage IV.
06:49
Keep in mind, staging always
means invasion in pathology.
06:53
And stage IV will
be one in which --
Well, now, the cancer,
it tends to do what?
Metastasize.
07:00
Your third type,
now what I wish to bring to your
attention is something here called rich.
07:05
All right,
this is a lymphocyte-rich.
07:08
Many times, students get this confused
with predominant and I could see as to why.
07:11
Because ultimately, in English,
by definition, they mean a lot.
07:16
However,
on your boards and on the wards,
rich, lymphocyte-rich type of Hodgkin
lymphoma will be completely different
than what’s coming up next, which we’ll
talk about as being lymphocyte predominant.
07:30
Keep that in mind and I'll reinforce
that when we get to the topic.
07:35
Now the type of Reed-Sternberg cell
here will be, once again, mononuclear.
07:38
Then here, it will be T
lymphocytes as being background,
lymphocyte-rich.
07:43
Uncommon.
07:44
Men once again more so than
women that are affected.
07:48
We have lymphocyte depleted,
you have a classic type.
07:51
Diffuse perhaps fibrosis, rare,
older males and perhaps
immunocompromised HIV,
lymphocyte depleted.
07:59
So we went from lymphocyte-rich
to lymphocyte depleted.
08:02
And then, here is the one
that I was referring to,
where by definition it
sounds like it’s a lot,
but be careful though.
08:10
These are 2 different
types of Hodgkin.
08:13
We have the rich,
as you see here.
08:15
And we have the predominant.
08:17
So this is nodular
lymphocyte predominant type.
08:21
Here, the type of Reed-Sternberg cell, and
I will show you a picture of this as well,
is called popcorn or used
to be called popcorn.
08:27
But you have to know this
as being L&H type of cell,
which stands for lymphocytic and
histiocytic type of Reed-Sternberg cell.
08:34
The background here will be more
so, a B-cell type.
08:37
Uncommon yet, once again,
it would be men that are affected more
so than women and it will be the young.
08:43
And it will be cervical axillary versus
mediastinal that we find with sclerosing.
08:48
Here are the 5 different
types of Hodgkin lymphoma.
08:51
By far, the most common
will be sclerosing type.
08:54
Take a few pointers
out of the rest
so that you’ll be able to
distinguish one from the other.
08:59
Understand that you know
as to which one of these
will be most likely
immunocompromised with HIV.
09:04
Well that’s easy,
because whenever there is HIV,
you’ll know that there is going
to be immune status compromise,
so lymphocyte depleted.
09:11
And popcorn or L&H will be something
with nodular lymphocyte predominant.