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

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.