HODGKIN’S LYMPHOMA

• Hodgkin’s lymphoma is a malignant neoplasm of lymphoreticular system.
• It can involve lymph nodes, spleen and liver.
• Common in males.
• Classic diagnostic feature is the presence of Reed- Sternberg (RS) cells or Dorothy- Reed Sternberg cells.
• Classic markers for Hodgkin’s disease is CD 15 & CD 30.

Classification –

I) Rye classification-

1. Lymphocyte- predominance type
2. Nodular- sclerosis type (most common)
3. Mixed- cellularity type
4. Lymphocyte- depletion type

II) According to WHO classification into 2 types-

1. Nodular lymphocyte- predominant HD
2. Classsic HD

 Etiology-

• EBV
• HIV cases

Pathology-

• Commonly involves left supraclavicular region.
• Nodes are enlarged without matting.
• Axial lymphatic system is almost always affected in Hodgkin’s disease.

Morphological features-

• Diagnosis of HD is by RS cells.
• RS cells have different subtypes-

1. Classic RS cell

• Characteristic bilobed nucleus.
• Nucleus contains inclusion like nucleolus with clear halo (owl- eye appearance)

2. Lacunar RS cells-

• It has pericellular space or lacuna.
• Found in nodular sclerosis.

3. Polyploid type (popcorn or lymphocytic histocytic type- LH) RS cells-

• Seen in lymphocyte predominance type of HD.
• Lobulated nucleus in the shape of popcorn.

4. Pleomorphic RS cells-

• Feature of lymphocyte depletion type.

Clinical features-

• Most commonly in patients present as painless, movable and firm lymphadenopathy.
• Cervical & mediastinal lymph nodes are involved most frequently.
• Splenomegaly & liver enlargement.
• Most common is low- grade fever with might sweat, weight loss, fatigue, malaise, weakness.

Lab findings-

• ical features shows mixed cellularity and neoplastic and non neoplastic cells seen.

Staging

Treatment-

1. Stage I/ II classical Hodgkin’s disease-

• Chemotherapy + field radiotherapy

2. Stage I/ II classical Hodgkin’s disease-

a) ABVD 4 to 6 cycles

• Doxorubicin
• Bleomycin
• Vinblastine
• Dacarbazine

b) MOPP regimen-

• Mechlorethamine
• Oncovin
• Procarbazine
• Prednisolone

3. Stage III/ IV classical HL-

• 6 cycles of ABVD chemotherapy cures.