Friday, January 7, 2011

Hodgkin Lymphoma.

HD, NODULAR SCLEROSIS type


HD, MIXED CELLULARITY type



HD, LYMPHOCYTE PREDOMINANT type


HD, LYMPHOCYTE DEPLETED type


Nodular sclerosis
Mixed cellularity
Lymphocyte-rich
Lymphocyte depletion
Lymphocyte predominance

Hodgkin`s lymphomas are most common of all lymphomas
All other types of lymphoma are called Non-Hodgkin lymphomas

Lymphomas are the neoplasm of the lymphatic tissue
Main lymphatic tissue is the lymph nodes

Although both types can develop into lymphoma cells, B-cell lymphomas are much more common than T-cell lymphomas.

It is the MOST COMMON form of lymphoma. HD is a disorder involving primarily the lymphoid tissues.
Initially single node or chain of nodes are involved then spreads characteristically to the anatomically contiguous nodes, thereby involving all lymphoid organs.
The germinal centre of the lymph node undergoes neoplastic transformation, which gives rise to characteristic Reed Sternberg cells
Two peaks in incidence seen
Around adolescence
Late Middle age to Old age

Etiology NOT clear
EBV is suspected in the etiology of Hodgkin’s disease

Once RS cell is formed, it elaborates many cytokines, like
IL-5 Eosinophil recruitment (in NS & MC types)
TGF-b Fibrosis or collagen deposition (in NS type)

MORPHOLOGY
The disease presents with considerable variety of microscopic patterns
REED STERNBERG CELL is the ONLY CONSTANT feature
Large cell (~45 μm diameter)
Bi-nucleate (Bi-lobed nucleus, appear as if a mirror image)
Owl eyed nucleolus
Peripheral clumping of chromatin

The variants (closely related cells) of RS cells

LACUNAR CELLS : characteristic of NS

MONONUCLEAR VARIANT

LYMPHOHISTIOCYTIC VARIANT (L & H CELL)
Irregular complex nucleus resembling pop corn kernel, small nucleoli, fine chromatin : specific to LP
The RS cell is a pre-requisite for the diagnosis of Hodgkin’s disease

They must be present in an appropriate background of NON NEOPLASTIC INFLAMMATORY CELLS (Plasma cells, Lymphocytes, Macrophages, Eosinophils, etc.)

HD, NODULAR SCLEROSIS type
- Most common form of HD
- Characterized by
1. Presence of Lacunar cell (a RS cell variant)
2. Presence of COLLAGEN BANDS that divide the lymphoid tissue into circumscribed nodules
- Prognosis is EXCELLENT
- Frequent mediastinal involvement

HD, MIXED CELLULARITY type
- Most common form of HD in ELDERLY
- Characterized by
1. Presence of classic RS cell & Mononuclear variant
2. Diffuse effacement of Lymph nodes
3. Background infiltrate rich in T cells, Plasma cells & Eosinophils
- Prognosis is GOOD
HD, LYMPHOCYTE PREDOMINANT type
- Quite uncommon
- Characterized by
1. Presence of L + H CELL (POPCORN cells) & few RS cell
2. Diffuse effacement of Lymph nodes
3. Background rich in small lymphocytes
- Prognosis is EXCELLENT
- Can progress into a diffuse large B cell lymphoma
HD, LYMPHOCYTE DEPLETED type
- Rare (Seen in HIV patients)
- Characterized by
1. Presence of many RS cells & Mononuclear cells
2. Diffuse fibrosis of Lymph nodes
3. Few lymphocytes
- Prognosis is POOR

SPREAD OF HODGKIN’S DISEASE
It has a PREDICTABLE spread or pattern
Nodal disease -- Splenic disease -- Hepatic disease -- Bone marrow involvement -- Extra lymphatic organ
Stage I & II disease is more common in Nodular sclerosis type
Stage III or IV is seen with Mixed cellularity type and LD

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