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Back to Oncology Diseases
Hodgkin's lymphoma
Pathology
Morphology
Classical Hodgkin's Lymphoma (95%)
CHL is defined by the presence of classic, diagnostic RS cells in
a background of either nodular sclerosis (NS), MC, or lymphocyte
depletion, with (when studied) the immunophenotype of CHL (CD15+
CD30+, T- and B-cell–associated antigens usually negative). CHL
includes NSHL, MCHL, and LDHL, as well as the proposed new category
of LRCHL. The immunophenotype, genetic features, and postulated
normal counterpart are the same for all of the classic types.
I) Nodular sclerosis (80%)
- Characterized by nodular growth pattern with fibrous bands
separating the nodules in most cases; diffuse areas are common,
as is necrosis. Capsular fibrosis frequently seen.
- A cytological spectrum of diseases ranging from an abundance
of lymphocytes with scanty Hodgkin's Reed-Sternberg (H-RS) cells
to a lymphocyte-depleted appearance with abundant tumor cells.
- predominant morphology of the H-RS cells is the lacunar
cell, characterized by lobulated nucleus, prominent
eosinophillic nucleolus and abundant clear cytoplasm.
- grading system devised by British
National Lymphoma Investigation recognized 2 grades:
- Grade II: an aggressive subtype that is characterized by 25% or more of
cellular nodules showing lymphocyte depleted or pleomorphic
cytological features.
- Grade I: All other cases including borderline cases
categorized as grade I (low grade).
II) Lymphocyte-rich classical Hodgkin's Lymphoma (5%)
Some cases of HL with RS cells of classic type, both by
morphology and immunophenotype, may have a background infiltrate
that consists predominantly of lymphocytes, with rare or no
eosinophils.
- Characterized by lymphocyte-rich cellular background containing typical H-RS
cells, maybe nodular or diffuse.
- when nodular, it is characterised by expanded mantle zone
regions colonized by H-RS cells. There is a relative paucity of
H-RS cells, histiocytes, plasma cells and eosinophils.
III) Lymphocyte depletion (1%)
The infiltrate in LDHL is diffuse and often appears hypocellular,
due to the presence of diffuse fibrosis and necrosis. There are
large numbers of RS cells and bizarre "sarcomatous" variants, with a
paucity of other inflammatory cells. Confluent sheets of RS cells
and variants may occur and rarely predominate (reticular variant or
Hodgkin's sarcoma).
- includes diffuse fibrosis and reticular Hodgkin's disease
from the Lukes and Butler classification.
- now very rarely diagnosed, and it is recognized that many
cases previously diagnosed as HD (lymphocyte-depletion) are in
fact examples of non-Hodgkin's lymphoma, commonly of anaplastic
large cell type
Anaplastic Large Cell Lymphoma.
- the majority of cases of show morphological features of
diffuse fibrosis characterized by a hypocellular background
containing bizarre H-RS cells and associated with non-collagenous
fibrosis.
IV) Mixed cellularity (20%)
- Classical Hodgkin's Lymphoma lacking histological features
which would otherwise permit classification as a specific
subtype.
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Nodular Lymphocyte Predominant Hodgkin's Lymphoma
(5%)
- may show partial or total nodal effacement by a nodular, or
nodular and diffuse proliferation of small lymphoid cells.
- a characteristic H-RS cell variant is present termed the L&H
(or 'popcorn') cell characterized by a lobulated and twisted
nucleus, and a nucleolus which is typically smaller than that
seen in H-RS cells of Classical HL.
- the number of popcorn cells is variable and may comprise up
to 10% of the cellular population within the nodules.
Collagenous fibrosis is uncommon.
- classical H-RS cells are extremely rare and are not required
for the diagnosis.
Transformation and progression
Classical HL
- relapsing cases have a tendency to increase the numbers of
H-RS cells present which maybe associated with depletion of
lymphoid cells
- the development of secondary NHL occurs in about 0.8% of
cases at 25yrs.
Nodular Lymphocyte Predominant HL
- relatively high frequency of developing secondary NHL (3.8%
at 25yrs), most of which are
diffuse large B-cell
lymphoma, but rare cases of
peripheral T-cell
lymphoma have been described.
- the development of secondary non-Hodgkin's lymphoma is
usually associated with multiple relapses.
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