Hodgkin’s lymphoma

Nodular lymphocytic predominat Hodgkins disease is now recognized as an entity distinct from classical Hodgkin’s disease.

In lymphocyte predominant Hodgkin’s disease Reed sterberg cells, eosinoplils, istocytes are sparse, and the predominant cell is a mature lymphocyte.

As a result, the disease may be mistaken for a diffuse small b-cell non-Hodgkin lymphoma.

Approximately 5% of patients with HL have the lymphocyte predominant (NLPHL) type.

It most often involves cervical or axillary lymph nodes.

It can affect patients of all ages, males more often than females, and symptoms such as fever, weight loss, and night sweats (also known as B symptoms) are infrequent. These patients are at risk for developing diffuse large B-cell lymphoma or T-cell/histiocyte-rich large B-cell lymphoma.

Ref:The MD Andersnn Manual of Medical Oncology, 2nd Edition, Chapter 10

Epstein-Barr virus is a cause of certain lymphomas and may play a role in the genesis of Hodgkin’s disease.

Ans. is ‘a’ i.e., Mixed cellularity seen in the background; ‘c’ i.e., Both neoplastic and non-neoplastic lymphocytes are seen

Distinct features of different types of Hodgkin lymphomas : ‑

Nodular sclerosis variant

• It is the most common variant.
• It is the only variant common in females.
• Most patients are young adults.
• Frequently involves mediastinum.
• Lacunar cells are present on histology.
• It has good prognosis —4 2^nd best after lymphocytic predominance.

Mixed cellularity variant

It is second most common variant.

• Has biphasic incidence, peaking in young adults and again in adults older than 55.
• More common in males.

o Mononuclear variants of Reed-Sternberg cells are present.

Lymphocyte depletion Type

• Least common type

o Worst prognosis

o There is paucity of lymphocytes.

o Pleomorphic variants of RS cell are present.

o Hodgkin cells (atypical histiocytes) are present.

• Predominant in older patients, HIV – positive individuals, or patients in developing countries.

o Most are EBV positive.

o More common in males.

Lvmphacytic Rich variant

• Reactive lymphocytes make up the vast majority of the cellular infiltrate.

o More common in males.

• It has very good to excellent prognosis. o 40% are EBV positive.

Lymphocyte predominance type

• Best prognosis

o Contains L & H (Popcorn cells) that are positive for CD 20.

o Common in young males.

o Follicular dendritic cells are seen.

The diagnosis of classical hodgkin lymphoma requires the presence of both the characteristic neoplastic Reed-Sternberg cells and the characteristic non-neoplastic cellular environment comprising of lymphocytes, histocytes, granulocytes, eosinophils and plasma cells.

Ans. is ‘c’ i.e. CD20 +

o CD 20 is positive in lymphocytic predominance variant (not in nodular sclerosis variant)

Pathology of nodular sclerosing variant

• Presence of lacunar variant of Reed-sternberg cells.

o Deposition of collagen in bands that divide the involved lymph nodes into circumscribed nodules.

• Fibrosis may be scant or abundant.

o The Reed-sternberg cells are found in a polymorphous back-ground of T-cells, eosinophils, plasma cells and macrophages.

Following information has been added in  of Robbins

o Classical Reed-sternberg cells are also positive for PAX5 (a B-cell transcription factor) alongwith CD15 and CD30.

Ans. is ‘d’ i.e. None of the above 

• Lymphoma is the second most common gastric malignancy after carcinoma stromach.
• It is of two types – Primary & Secondary
• Primary gastric lymphoma is mainly (>95%) Non-Hodgkins type. Most of the primary lymphomas (about 60%) arise in MALT (mucosa associated lymphoid tissue). MALT is usually associated with chronic H. pylori infection. So low-grade MALT lymphomas are thought to arise because of chronic H. pylori infection. These low grade lymphomas may later on degenerate to high grade lymphomas.
• Secondary
• Stomach is the most common extranodal site of systemic lymphoma.
• Almost all of them are Non-Hodgkins types
• Hodgkin’s disease involving the stomach is extremely uncommon.
• Note that treatment of primary high grade lymphoma is controversial. There are slightly different opinions in Schwartz, Harrison & CMDT.

Ans. is ‘c’ i.e., Lymph node biopsy 

Answer is B (Read Sterberg cells)

Hodgkin’s Lymphoma is characterized morphologically by the presence of distinctive neoplastic giant cells called Read

Answer is A (CD15 and CD30)

The tumor cells in Hodgkins Lymphoma are characteristically positive for CDI5 and CD30 and negative for CD45.

Lymphocyte predominance Hodgkins Lymphoma is the only histological subtype that does not express CDI5 and CD30. This subtype expresses CD45 and is often considered as an entirely distinct category from classical Hodgkin’s disease (Harrisons)

Answer is C (Absolute lymphocyte count < 600/mm3)

An absolute Lymphocyte count ofsymptoms)

These factors predict prognosis in patients with clinical stages I and II in Hodgkin’s disease.

Answer is A (Younger age)

Lymphocyte depletion subtype, presence of mediastinal disease and systemic manifestation are all established poor prognostic factors

Stomach involvement reflects advanced stage of disease and is likely to be associated with a poor prognosis.

Ans. B i.e. Palpable lymphadenopathy

Hodgkins lymphoma

• Malignant cells of Hodgkin’s disease are: Reed Sternberg cells/ RS
• RS cells are positive for:

—        CD15 and

—        CD30

• Subtype of Hodgkin’s disease, which is NOT positive for CD15 and CD30: Lymphocytic predominant
• Lacunar cells are seen in: Nodular sclerosis type of lymphoma
• Hilar lymphadenopathy is a feature of: Nodular sclerosis type
• MC type of Hodgkins lymphoma: Nodular sclerosing
• MC type of Hodgkins lymphoma in India: Mixed cellularity

Ans. A: CNS is the commonest site of involvement

The nodes may also feel rubbery and swollen when examined.

The nodes of the neck and shoulders (cervical and supraclavicular) are most frequently involved (80-90% of the time, on average).

The lymph nodes of the chest are often affected

Central nervous system (CNS) involvement by Hodgkin lymphoma (HL) is rare.

Ans. is ‘c’ i.e., Lymphocyte predominant

Popcorn cells are found in lymphocytic predominant type of Hodgkin’s Lymphoma.