Our topic now brings us
to Hodgkin’s lymphoma.
Whenever you deal with Hodgkin lymphoma,
you should be thinking and contrasting
non-Hodgkin’s lymphoma (NHL).
There are some general
features with Hodgkin
that do not exist with non-Hodgkin that
you need to be quite familiar with.
And that entire category of
NHL or non-Hodgkin’s lymphoma
was quite important for us.
With Hodgkin, presents in a single lymph
node or several adjacent lymph node.
The type of spread that you find
with Hodgkin is called contiguous.
Non-Hodgkin’s lymphoma, it will
be non-contiguous, more common.
In Hodgkin, it's confined to lymph
node with little extranodal component.
you’d find there to be extranodal
involvement to be quite common.
In Hodgkin, spreads in
a contiguous fashion.
What does that mean?
From one node to adjacent lymph node.
Maybe from the mediastinum
to the cervical lymph node.
However with non-Hodgkin,
it will be non-contiguous.
With Hodgkin, we have absolutely,
the most important point,
histologically you must find a particular
B-cell lymphoma or B-cell, excuse me.
In that particular B-cell, I will
show you patterns, morphologically,
of Reed-Sternberg cell.
In pathology, we call this owl eyes.
And when the time is right, I’ll walk you
through different types of Reed-Sternberg.
If you do not find Reed-Sternberg cell,
either in description or upon histology,
you cannot diagnose your
patient with Hodgkin.
Little is known.
However, Reed-Sternberg cells show
evidence of EBV infection oftentimes.
Well, I will walk you through
different types of Hodgkin,
and I will also give you what
the most common type would be.
One would be called nodular sclerosing and
the other type would be mixed cellular.
Our focus will be on those 2.
Your focus really should be on
nodular sclerosing as you shall see.
But there is evidence of EBV, very
much being involved with Hodgkin.
The surrounding inflammatory stroma
results from expression of cytokines.
So here from the Reed-Sternberg
cell which is technically B-cell,
you would expect B-cells to release
cytokines and perhaps TNF.
No exception here.
You have a cancer cell,
a Reed-Sternberg cell,
which is behaving like a B-cell
but it is pathological.
An important table for you to understand
your different types of Hodgkin lymphoma.
Subtype nodular sclerosis
would be the most common.
Hence, you pay
attention to this.
Now, before we move on, where
is my cancer originating from?
From the lymph node.
Anytime you see the word lymphoma,
non-Hodgkin lymphoma or Hodgkin lymphoma,
the origin of the cancer
will be from the lymph node.
Is there a possibility that it
might enter the circulation?
Absolutely, so therefore you might
have a leukemic type of picture.
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.
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.
Keep that in mind.
The behavior could be rather
similar in presentation.
However, how it got there,
Now when you say sclerosing,
what is undergoing
The lymph node.
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.
And what happens here is that the lymph
node will then undergo sclerosing.
In other words, narrowing or
scarring or, in other words,
there is more or less
fibrotic type of change.
You lose the normal
architecture of the lymph node.
I will show you different
types of Reed-Sternberg cell.
At this point,
I would recommend that you memorize lacunar
and classic type of Reed-Sternberg.
Let me give you a brief description.
you would expect there to be quite
a bit of space within the cell, okay?
Wide vacuoles or enlarged
vacuoles, lacunar type.
you still would have to find these owl
eyes and I will show you those coming up.
The background here, bands of
fibrosis, fibrosis, fibrosis.
That’s where your
focus should be.
And by fibrosis, I mean the
lymph node is becoming fibrosed.
When it does, what then happens
to the actual structure?
As you would expect
And so therefore, this will then
refer to as being sclerosing.
Those are 2 big points,
architecture in the
Reed-Sternberg and the types.
Now, the third big point will
be the clinical feature.
Most of your Hodgkin lymphoma, in fact,
will be affecting males, males, males.
Nodular sclerosing is an exception
where you will find here
that not that there are more females that
have greater preponderance over males.
it’s just the fact that
men and women are equally
at risk of developing
Young adults, and I will talk to
you about staging in great detail.
I have to.
Pay attention to stage I and II.
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.
Mediastinal lymph nodes
often times are involved.
And if the lymph nodes are involved,
understand that this is
a cancer, so therefore,
these lymph nodes
will be nontender.
I'll spend some time
with nodular sclerosing
more than I would with
any other type here.
Because it is the most common.
Once you get past this,
then you take out a few notes from the
remaining types of Hodgkin lymphoma.
We have mixed cellularity.
M – mixed cellularity,
M – mononuclear.
Use that to your advantage.
I will show you a picture of a Reed-Sternberg
cell that will be mononuclear type.
The background here will be
mixed, mixed cellularity.
once again, we’ll get back to
the normal preponderance in men
or men being more
affected than women.
All ages here, not so much young and look
for mixed particularly in the elderly.
And that’s important.
And also association with EBV.
And then I will talk to you
about stage III and stage IV.
Keep in mind, staging always
means invasion in pathology.
And stage IV will be one in which --
Well, now, the cancer, it tends to do what?
Your third type,
now what I wish to bring to your
attention is something here called rich.
All right, this is a lymphocyte-rich.
Many times, students get this confused with
predominant and I could see as to why.
Because ultimately, in English,
by definition, they mean a lot.
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.
Keep that in mind and I'll reinforce
that when we get to the topic.
Now the type of Reed-Sternberg cell
here will be, once again, mononuclear.
Then here, it will be T
lymphocytes as being background,
Men once again more so than
women that are affected.
We have lymphocyte depleted,
you have a classic type.
Diffuse perhaps fibrosis, rare,
older males and perhaps
So we went from lymphocyte-rich
to lymphocyte depleted.
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.
These are 2 different types of Hodgkin.
We have the rich, as you see here.
And we have the predominant.
So this is nodular
lymphocyte predominant type.
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.
But you have to know this
as being L&H type of cell,
which stands for lymphocytic and
histiocytic type of Reed-Sternberg cell.
The background here will
be more so, a B-cell type.
Uncommon yet, once again,
it would be men that are affected more
so than women and it will be the young.
And it will be cervical axillary versus
mediastinal that we find with sclerosing.
Here are the 5 different
types of Hodgkin lymphoma.
By far, the most common
will be sclerosing type.
Take a few pointers
out of the rest
so that you’ll be able to
distinguish one from the other.
Understand that you know
as to which one of these
will be most likely
immunocompromised with HIV.
Well that’s easy, because
whenever there is HIV,
you’ll know that there is going
to be immune status compromise,
so lymphocyte depleted.
And popcorn or L&H will be something
with nodular lymphocyte predominant.