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Lymphadenopathy: Hodgkin Lymphoma (Hodgkin's Disease) – White Blood Cell Pathology

by Carlo Raj, MD
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    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, 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.

    01:47 Etiologies: Little is known.

    01:50 However, Reed-Sternberg cells show evidence of EBV infection oftentimes.

    01:56 Well, I will walk you through different types of Hodgkin, and I will also give you what the most common type would be.

    02:01 One would be called nodular sclerosing and the other type would be mixed cellular.

    02:06 Our focus will be on those 2.

    02:08 Your focus really should be on nodular sclerosing as you shall see.

    02:13 But there is evidence of EBV, very much being involved with Hodgkin.

    02:17 The surrounding inflammatory stroma results from expression of cytokines.

    02:22 So here from the Reed-Sternberg cell which is technically B-cell, you would expect B-cells to release cytokines and perhaps TNF.

    02:30 No exception here.

    02:31 You have a cancer cell, a Reed-Sternberg cell, which is behaving like a B-cell but it is pathological.

    02:42 An important table for you to understand your different types of Hodgkin lymphoma.

    02:49 Subtype nodular sclerosis would be the most common.

    02:51 Hence, you pay attention to this.

    02:53 Now, before we move on, where is my cancer originating from? From the lymph node.

    03:00 Anytime you see the word lymphoma, non-Hodgkin lymphoma or Hodgkin lymphoma, the origin of the cancer will be from the lymph node.

    03:09 Is there a possibility that it might enter the circulation? Well, absolutely.

    03:14 Absolutely, so therefore you might have a leukemic type of picture.

    03:18 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.

    03:33 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.

    03:42 Keep that in mind.

    03:43 The behavior could be rather similar in presentation.

    03:47 However, how it got there, that’s important.

    03:50 Now when you say sclerosing, what is undergoing sclerotic process? The lymph node.

    03:57 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.

    04:05 And what happens here is that the lymph node will then undergo sclerosing.

    04:08 In other words, narrowing or scarring or, in other words, there is more or less fibrotic type of change.

    04:15 You lose the normal architecture of the lymph node.

    04:19 I will show you different types of Reed-Sternberg cell.

    04:22 At this point, I would recommend that you memorize lacunar and classic type of Reed-Sternberg.

    04:29 Let me give you a brief description.

    04:31 Lacunar, you would expect there to be quite a bit of space within the cell, okay? Wide vacuoles or enlarged vacuoles, lacunar type.

    04:41 However, you still would have to find these owl eyes and I will show you those coming up.

    04:46 The background here, bands of fibrosis, fibrosis, fibrosis.

    04:49 That’s where your focus should be.

    04:51 And by fibrosis, I mean the lymph node is becoming fibrosed.

    04:54 When it does, what then happens to the actual structure? As you would expect with fibrosis, contracture.

    05:01 And so therefore, this will then refer to as being sclerosing.

    05:05 Those are 2 big points, architecture in the Reed-Sternberg and the types.

    05:10 Now, the third big point will be the clinical feature.

    05:13 Most of your Hodgkin lymphoma, in fact, will be affecting males, males, males.

    05:19 Nodular sclerosing is an exception where you will find here that not that there are more females that have greater preponderance over males.

    05:29 it’s just the fact that men and women are equally at risk of developing Hodgkin lymphoma.

    05:35 Young adults, and I will talk to you about staging in great detail.

    05:39 I have to.

    05:40 Pay attention to stage I and II.

    05:42 That will make more sense to you as I go through.

    05:44 A particular classification that will be responsible for every stage as we go through them.

    05:51 Mediastinal lymph nodes often times are involved.

    05:54 And if the lymph nodes are involved, understand that this is a cancer, so therefore, these lymph nodes will be nontender.

    06:01 I'll spend some time with nodular sclerosing more than I would with any other type here.

    06:06 Because it is the most common.

    06:08 Once you get past this, then you take out a few notes from the remaining types of Hodgkin lymphoma.

    06:16 We have mixed cellularity.

    06:17 M – mixed cellularity, M – mononuclear.

    06:22 Use that to your advantage.

    06:23 I will show you a picture of a Reed-Sternberg cell that will be mononuclear type.

    06:28 The background here will be mixed, mixed cellularity.

    06:31 And here, once again, we’ll get back to the normal preponderance in men or men being more affected than women.

    06:39 All ages here, not so much young and look for mixed particularly in the elderly.

    06:46 And that’s important.

    06:47 And also association with EBV.

    06:50 And then I will talk to you about stage III and stage IV.

    06:54 Keep in mind, staging always means invasion in pathology.

    06:57 And stage IV will be one in which -- Well, now, the cancer, it tends to do what? Metastasize.

    07:05 Your third type, now what I wish to bring to your attention is something here called rich.

    07:10 All right, this is a lymphocyte-rich.

    07:12 Many times, students get this confused with predominant and I could see as to why.

    07:16 Because ultimately, in English, by definition, they mean a lot.

    07:21 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.

    07:34 Keep that in mind and I'll reinforce that when we get to the topic.

    07:39 Now the type of Reed-Sternberg cell here will be, once again, mononuclear.

    07:43 Then here, it will be T lymphocytes as being background, lymphocyte-rich.

    07:48 Uncommon.

    07:49 Men once again more so than women that are affected.

    07:53 We have lymphocyte depleted, you have a classic type.

    07:55 Diffuse perhaps fibrosis, rare, older males and perhaps immunocompromised HIV, lymphocyte depleted.

    08:04 So we went from lymphocyte-rich to lymphocyte depleted.

    08:07 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.

    08:15 These are 2 different types of Hodgkin.

    08:17 We have the rich, as you see here.

    08:20 And we have the predominant.

    08:22 So this is nodular lymphocyte predominant type.

    08:26 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.

    08:31 But you have to know this as being L&H type of cell, which stands for lymphocytic and histiocytic type of Reed-Sternberg cell.

    08:39 The background here will be more so, a B-cell type.

    08:41 Uncommon yet, once again, it would be men that are affected more so than women and it will be the young.

    08:47 And it will be cervical axillary versus mediastinal that we find with sclerosing.

    08:53 Here are the 5 different types of Hodgkin lymphoma.

    08:55 By far, the most common will be sclerosing type.

    08:59 Take a few pointers out of the rest so that you’ll be able to distinguish one from the other.

    09:03 Understand that you know as to which one of these will be most likely immunocompromised with HIV.

    09:09 Well that’s easy, because whenever there is HIV, you’ll know that there is going to be immune status compromise, so lymphocyte depleted.

    09:16 And popcorn or L&H will be something with nodular lymphocyte predominant.


    About the Lecture

    The lecture Lymphadenopathy: Hodgkin Lymphoma (Hodgkin's Disease) – White Blood Cell Pathology by Carlo Raj, MD is from the course Lymphadenopathy – White Blood Cell Pathology (WBC).


    Included Quiz Questions

    1. … in a single lymph node along with little extranodal component.
    2. … in a single lymph node along with no extranodal component.
    3. … in multiple lymph nodes along with excessive extranodal component.
    4. … in multiple lymph nodes along with no extranodal component.
    5. … in multiple lymph nodes along with little extranodal component.
    1. Partially nodular growth pattern, with fibrous bands separating the nodules.
    2. Abundant RS cells
    3. Very low lymphocytic count
    4. Early hematogenous spread
    5. Never associated with areas of necrosis
    1. Nodular lymphocyte predominant
    2. Lymphocyte depleted
    3. Nodular sclerosis
    4. Lymphocyte-rich
    5. Mixed cellularity
    1. Nodular lymphocyte predominant
    2. Nodular sclerosis
    3. Mixed cellularity
    4. Lymphocyte-rich
    5. Lymphocyte depleted
    1. Stage III or IV
    2. Stage II
    3. Stage III
    4. Stage I or II
    5. Stage V

    Author of lecture Lymphadenopathy: Hodgkin Lymphoma (Hodgkin's Disease) – White Blood Cell Pathology

     Carlo Raj, MD

    Carlo Raj, MD


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