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 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. Stage I or II
    2. Stage III
    3. Stage III or IV
    4. Stage IV
    5. Stage V
    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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