Hodgkin Lymphoma

What is Hodgkin lymphoma (HL)?

A malignant lymphoma characterized by the presence of Reed-Sternberg cells derived from B lymphocytes.

What is the hallmark cell of Hodgkin lymphoma?

Reed-Sternberg cell with bilobed “owl-eye” nuclei and prominent nucleoli.

What is the cell of origin of Reed-Sternberg cells?

Germinal center B cells.

What immunophenotype is typical for classical Hodgkin lymphoma?

CD15+ and CD30+.

What is the typical age distribution of HL?

Bimodal: young adults and older adults.

What is the most common presentation of HL?

Painless lymphadenopathy, often in cervical region.

What are B symptoms in HL?

Fever, night sweats, and unintentional weight loss.

What is Pel-Ebstein fever?

Cyclic fever pattern sometimes seen in Hodgkin lymphoma.

What is the pattern of spread in HL?

Contiguous spread from one lymph node group to adjacent nodes.

How does HL differ from non-Hodgkin lymphoma spread?

HL spreads contiguously, NHL spreads non-contiguously.

What is the most common subtype of HL?

Nodular sclerosis.

What are characteristic features of nodular sclerosis HL?

Lacunar cells and fibrosis dividing lymph node into nodules.

What subtype of HL is associated with EBV?

Mixed cellularity subtype.

What is the worst prognosis subtype of HL?

Lymphocyte-depleted subtype.

What is nodular lymphocyte-predominant HL?

A variant lacking CD15/CD30, positive for CD20, with “popcorn” cells.

What are “popcorn cells”?

Variant Reed-Sternberg cells with multilobulated nuclei.

What causes symptoms in HL?

Cytokine release from Reed-Sternberg cells and reactive immune cells.

Why are Reed-Sternberg cells few in number?

Tumor mass is largely reactive inflammatory cells recruited by cytokines.

What is the Ann Arbor staging system?

A classification based on extent of lymph node and extranodal involvement.

What defines Stage I HL?

Single lymph node region involved.

What defines Stage II HL?

Multiple lymph nodes on one side of diaphragm.

What defines Stage III HL?

Lymph nodes on both sides of diaphragm.

What defines Stage IV HL?

Diffuse extranodal involvement such as liver or bone marrow.

What does “A” vs “B” indicate in staging?

A = no systemic symptoms, B = presence of B symptoms.

What is a common mediastinal finding in HL?

Mediastinal mass, especially in nodular sclerosis subtype.

What lab abnormalities may be seen in HL?

Elevated ESR and anemia.

What is the role of biopsy in HL diagnosis?

Confirms presence of Reed-Sternberg cells.

What is the role of PET/CT in HL?

Used for staging and monitoring treatment response.

What is the primary treatment for HL?

Combination chemotherapy (e.g., ABVD regimen).

What drugs are in ABVD regimen?

Adriamycin, bleomycin, vinblastine, dacarbazine.

What is the role of radiation therapy in HL?

Used for localized disease or adjunct to chemotherapy.

What is the prognosis of HL?

Generally excellent with high cure rates.

What factors worsen prognosis in HL?

Advanced stage, B symptoms, older age, and relapse.

What is the cure rate for early-stage HL?

High, often >90 percent.

What is the cure rate for advanced HL?

Lower but still favorable with treatment.

What is a complication of HL treatment?

Risk of secondary malignancies and infertility.

What is the relationship between EBV and HL?

EBV infection contributes to malignant transformation of B cells.

What is the microenvironment in HL?

Reactive inflammatory cells surrounding Reed-Sternberg cells.

Why do HL patients experience pruritus?

Cytokine-mediated effects.

What is the role of immune evasion in HL?

Reed-Sternberg cells evade immune detection despite immune-rich environment.

What is the significance of CD30 expression?

Target for therapy such as brentuximab vedotin.

What is brentuximab vedotin?

Anti-CD30 antibody-drug conjugate used in HL treatment.

What is relapse in HL?

Return of disease after initial remission.

How is relapsed HL treated?

Salvage chemotherapy and stem cell transplant.

What is autologous stem cell transplant?

Patient’s own stem cells used after high-dose chemotherapy.

What is the hallmark clinical takeaway of HL?

Highly treatable lymphoma with characteristic Reed-Sternberg cells and contiguous spread.