Lymphoma down arrow

 

Hodgkin Lymphoma

 

 

Histologic Subtypes

 

Hodgkin Lymphoma (HL) is divided into 2 main categories defined by the REAL (Revised European American Lymphoma) Update of the WHO classification:

  • Classical HL
  • Nodular Lymphocyte Predominant Hodgkin Lymphoma (NLPHL)

 

Classical Hodgkin Lymphoma

Classical Hodgkin Lymphoma is further divided into 4 histologic subtypes according to:

  • Number and morphology of Reed-Sternberg cells
  • Composition of cellular background in the biopsied material. 

 

The 4 subtypes of Classical Hodgkin Lymphoma are:

  • Nodular sclerosis
  • Mixed cellularity
  • Lymphocyte depleted
  • Lymphocyte rich.

 

Pathological summary of classical Hodgkin lymphoma subtypes:

Nodular

Sclerosis

Mixed Cellularity

Lymphocyte Depleted

Lymphocyte Rich

Proportion of children

40-50%

30-35%

<5%

<1%

Proportion of adolescents

70-80%

10-15%

Type of R-S

Lacunar

Classical (most)

Mononuclear (few)

Lacunar (few)

Classical

Bizarre sarcomatous

Classical

Quantity

of R-S

Varies

Varies

Abundant

Few

Infiltrate Composition

Lymphocytes

Histiocytes

Plasma cells

Eosinophils

Neutrophils

Lymphocytes

Epitheloid histiocytes

Eosinophils

Plasma cells

Limited inflammatory cells

Lymphocytes

Histiocytes

Cellular pattern

Partially nodular

Diffuse and vaguely nodular             

Diffuse and hypocellular

Diffuse or nodular

Morphological Features

Capsular/intranodal

  fibrosis

 

Fibrous bands divide lymph nodes into  nodules

 

Areas of necrosis

No band-forming  sclerosis

 

 

Reactive follicular  hyperplasia

Paucity of lymphocytes

 

Diffuse fibrosis

 

Necrosis

Diffuse:

predominance of small T lymphocyte and no germinal centre involvement

 

Nodular:

resembles follicular

Other

Mediastinum

(above the diaphragm)

Common sites: abdominal lymph nodes and spleen

Confused with peripheral T-cell lymphoma

Frequently misdiagnosed with non-Hodgkin’s anaplastic large cell type

Sometimes difficult to distinguish from nodular lymphocyte predominant HD

Prognosis Better prognosis Intermediate amongst the classical subtypes Worst amongst the classical subtypes Better prognosis

 

Nodular Lymphocyte Predominant Hodgkin Lymphoma (NLPHL)

Please see next page

 

 

 

 

 

Back to top

Next