Upon morphology of Hodgkin lymphoma,
what you want to do is with this
illustration or these illustrations,
you compare these with the previous
discussion that we had on the table,
where you have the different
types of morphology of what?
The topic for this entire section is
morphology of Reed-Sternberg cell.
You must find the Reed-Sternberg
cell so that you can do what?
If you do not find an owl eye
type of appearance upon histology
and your patient has B symptoms.
What do B symptoms mean to you?
Night sweats, weight
loss and you have fever.
Sounds an awful lot like TB,
but B symptoms could be found
both on Hodgkin and non-Hodgkin.
Reed-Sternberg cell, only Hodgkin.
The classic type,
take a look at this.
And it looks like owl
eyes, doesn’t it?
You have the nucleoli which
is looking right back at you.
Then you have the lacunar type.
I want you to pay closer
attention to the lacunar
and the one that you’re paying attention
to is the one in the upper left corner.
And you find a lot more space or
vacuolization, that’s a lacunar type.
Remember that classic and lacunar could
be found with the sclerosing type
of Hodgkin, being
the most common.
And I want you to move
down to the mononuclear.
With the mononuclear, what
looks like a mononucleus
and, in addition, the mononuclear
variant will be found with mixed
more so cellularity type
of Hodgkin, M and M.
And then bottom right,
you find your popcorn cells or L&H
(lymphocytic and histiocytic)
and this type of Reed-Sternberg
cell will be found with
Four different variants
of Reed-Sternberg cell.
If I were you, I’d be very comfortable
with being able to identify
each one of these types
of Reed-Sternberg cell
based on the type of Hodgkin that
your patient is presenting with.
Now the Reed-Sternberg and
morphology, the description.
The classic Reed-Sternberg cells are large.
We'll walk through the description.
With abundant pale cytoplasm and
two or more oval lobulated nuclei
containing prominent “owl
eye” eosinophilic nucleoli.
I will pause here for one second
and make sure that you repeat
this a few times to yourself.
So that when you read this
in a stem of a question,
that you will know that you’re
referring to the Reed-Sternberg cell.
They might not, at all times,
come out and say Reed-Sternberg,
but they will go ahead and tell you
that there is quite a bit of cytoplasm
and you have these oval lobulated
nuclei giving you the owl eye
with eosinophilic nucleoli.
In some Reed-Sternberg cell
variants, the cytoplasm shrinks
and due to this, it then appears as though
that you have quite a bit of emptiness
around the nucleus.
Don’t worry about the mechanism of
the shrinkage, that’s not important.
Be able to identify
a lacunar cell.
So there is going to be increased emptiness
or vacuolization around the nucleus.
And I’ve shown you picture
in the previous discussion.
Make sure you know the description
of lacunar and your classic.
And then you have the L&H.
The L&H, if you go back and take
a look at the picture, is fluffy.
It looks lobulated and looks
Here, this type of variant is found
with nodular lymphocyte predominant.
Keep those separate.
In this section, we’ll
have to walk you through
Ann Arbor classification
in great detail.
Every single stage, you must know
because of Hodgkin and
because of prognosis.
Let’s begin with stage I.
Stage I is one lymph
The specific classification is called
Ann Arbor, only for Hodgkin here,
One lymph node affected and if it’s
something like your sclerosing type,
may be the mediastinum or the patient
said, “Doc I have a lump in my neck.”
Does it hurt?
Your concern upon biopsy, you find
a Reed-Sternberg cell.
A nuclei that are lobulated,
looking back at you, “owl eyes”.
And in addition, you find a
classic type or a lacunar.
You might be thinking about nodular
sclerosing especially if it’s a female.
Stage II, you have two or more
lymph nodes that are affected,
but only one side of the diaphragm.
Locate the diaphragm to yourself please
And on one side of diaphragm you have
2 lymph nodes that are affected.
Maybe the cervical or
maybe the mediastinal.
Obviously, they are nontender.
Now, we go from stage II to stage III
and this is a pretty extensive change.
What happens now is the
fact that you have two
or more lymph nodes on either
side of the diaphragm.
So if by chance you find involvement of
your, let’s say, mediastinal lymph node
and then you find
involvement of the spleen.
From henceforth, you must think of the
spleen pathologically as being a lymph node.
Please do that.
So therefore if you have one lymph node
that is affected by the mediastinum
and you have another lymph node
that has affected “the spleen”
that will be the other side of the
diaphragm, that is 2 or more,
so you satisfied that
criteria, in addition,
you’re on either side of diaphragm,
both sides of diaphragm.
This is not stage I,
definitely not stage II.
In fact this is stage III.
You’re on both sides
of the diaphragm.
Once you’re at stage IV,
unfortunately, extralymphatic spread,
But even with this though,
prognosis pretty decent.
These are stages of Hodgkin lymphoma.
Spend a little bit of time especially
with stage II and stage III
so that you understand as to when
you've moved from stage II to stage III
depending as to what side
of diaphragm you’re on,
or on one side or both sides.
Clinical presentation of Hodgkin, the B
symptoms include once again, what are they?
Fever, weight loss and night sweats.
We have gone over that over and over again.
At this point, I expect
you to know what that is.
Do not confuse this
with TB, tuberculosis.
Prognosis depends on stage, but
even with the later stages,
what is the name of staging
mechanism of Hodgkin?
It’s called Ann Arbor.
It’s still generally good.
Or even stage IV, take a look at this.
Very rarely can you get
to stage IV in a cancer
and have such decent, decent
type of survival rate,
60%-70% 5-year survival.
And it’s important that
you know the CD markers.
Go in 15s.
Pay attention to 15 and 30 and 45;
15 positive, 30
positive, 45 negative;
15, 30, 45.
Memorize the 15 and 30 will be
positive and 45 will be negative.
Those three for sure, you need
to make sure that you know.
All of your Hodgkin lymphoma
will be of that pattern
of cluster differentiation
except for the popcorn.
All right. The popcorn was the one
that we talked about L&H.
And that is the one that is called
nodular lymphocyte predominant.
And that will be one in which 15,
30 negative and 45 positive.
But your focus should be on
15, 30 positive for sure.