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Hodgkin
Lymphoma
Jason Ryan, MD, MPH
Lymphomas
• Malignancies of lymphocytes (B cells, T cells)
• Often involve lymph nodes
• Also “extranodal” (skin, GI tract)

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Wikipedia/Public Domain
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Lymphomas
Signs and Symptoms

• Enlarged, painless lymph nodes

• “B symptoms”
• Systemic symptoms
• Fever, chills, night sweats
Lymphomas
Tissue
Biopsy

Malignant Lymphocytes
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Reed-Sternberg
Cells?
No Yes

Non-Hodgkin Hodgkin
Lymphoma Lymphoma
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Reed-Sternberg Cells
• Large cell
• Multi-lobed nucleus
• Two halves; often mirror images (“owl-eyed”)
• Usually derive from B cells (rarely from T cells)
• Usually CD15+ and CD30+
• Usually NOT positive for B cell markers
• CD19, CD20, CD21, CD22
• Sometimes seen in other disorders
Reed-Sternberg Cells

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Nva1991/Wikipedia
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Hodgkin Lymphoma
• Malignant cell: Reed-Sternberg cell
• A minority of cells in enlarged nodes (~1 to 5%)
• Release cytokines → generate reactive cells
• Majority of cells in node are reactive
• B symptoms common (more than non-Hodgkin lymphoma)
• Macrophages may activate → hypercalcemia

1α - hydroxylase 1,25-OH Vitamin D

25-OH Vitamin D 2
Hodgkin Lymphoma
• Commonly presents with cervical lymphadenopathy
• Often with B symptoms
• Spreads in a very predictable manner
• Limited disease highly curable
• Stage is strongest predictor of prognosis
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Hodgkin Lymphoma
• Bimodal age distribution
• Peaks at age 20 and 65
• Risk factors
• Prior EBV infection (virus infects B cells)
• Immunosuppression (HIV, transplant)
• Autoimmune disease: Rheumatoid arthritis and lupus
• Treatment: chemotherapy and radiation
Classification

Hodgkin Lymphoma

Nodular
Classical AfraTafreeh.com lymphocyte
(cellular background ) predominant

Nodular Mixed Lymphocyte Lymphocyte

Sclerosing Cellularity Rich Depleted
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Lymphocyte Predominant
Nodular Lymphocyte Predominant

• Rare variant of Hodgkin lymphoma

• Malignant cell: LP cells
• Lymphocyte predominant
• Sometimes called “popcorn cells”
• Unusual surface marker expression
• Usually lack CD15 and CD30
• Express CD20
Popcorn Cells

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Nephron/Wikipedia
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Classical Hodgkin Lymphoma

• Nodular sclerosing
• Most common type HL: 60% to 80% of all cases
• More common in women (most HL more common men)
• Often presents with a mediastinal mass on CXR
• Reed-Sternberg cells seen in clear space (“lacunar variant”)
• Slow growing (“indolent”)
• Good long-term survival
Classical Hodgkin Lymphoma
• Mixed cellularity
• Eosinophils, neutrophils, macrophages, plasma cells
• Lymphocyte rich
• Excellent prognosis
• Lymphocyte depletedAfraTafreeh.com
• Poor prognosis
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Hodgkin versus. Non-Hodgkin

Clinical Features

Hodgkin Non-Hodgkin
• Often localized • Often multiple
• Orderly spread from peripheral sites
node to node • Noncontiguous spread
• Extranodal involvement • Extranodal involvement
rare common
• GI (thickened bowel wall)
• Skin
Hodgkin Lymphoma
Treatment

• Many different regimens

• ABVD
• Adriamycin (doxorubicin) - cytotoxic antibiotics
• Bleomycin - cytotoxic antibiotics
• Vinblastine – microtubule inhibitor
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• Dacarbazine – alkylating agent