PATHO - WBC and Lymph Nodes 3 (Hodgkin Lymphoma)

32 years

Average age of diagnosis for Hodgkin lymphoma?

Hodgkin lymphoma

Most common cancer of young adults and adolescents?

Hodgkin lymphoma

First human cancer successfully treated with chemotherapy and radiation?

Germinal center B cell

Origin of Reed-Sternberg cells?

Reactive lymphocytes, macrophages, granulocytes

Reed-Sternberg cells induce accumulation of what cells?

90%

Percentage of reactive cells in Hodgkin lymphoma tumor mass?

Reed-Sternberg cell

Giant neoplastic cell characteristic of Hodgkin lymphoma?

Owl eyes

Common nickname for Reed-Sternberg cell nuclear appearance?

Five

Total number of subtypes of Hodgkin lymphoma?

Nodular sclerosis, mixed cellularity, lymphocyte rich, lymphocyte depletion

Subtypes classified as “classical” Hodgkin lymphoma?

Nodular lymphocyte predominance

Non-classical subtype of Hodgkin lymphoma?

CD15+, CD30+, CD20-, CD45-

Reed-Sternberg phenotype in classical Hodgkin lymphoma?

CD20+, BCL6+, CD15-, CD30-

RS phenotype in non-classical (nodular lymphocyte predominance) type?

Germinal or post-germinal center B cell

Cell of origin of Reed-Sternberg cells?

NF-KB

Transcription factor activated in most classical Hodgkin lymphomas?

LMP-1

Viral protein from EBV that activates NF-κB?

IKB and TNF-a-induced protein 3

Two gene regulators lost in EBV– tumors activating NF-κB?

Reed-Sternberg cell

Diagnostic hallmark cell in Hodgkin lymphoma?

Owl eyes

Nuclear appearance of Reed-Sternberg cells?

Equal

RS cell size compared to small lymphocyte nucleolus?

Abundant

Cytoplasm of RS cell?

Mononuclear variant

RS variant with single nucleus and large nucleolus?

Lacunar cell

RS variant with folded nucleus and disrupted pale cytoplasm?

Sits in empty space or lacuna

Appearance of lacunar cell nucleus?

L&H (popcorn) cell

RS variant with polyploid nuclei and inconspicuous nucleoli?

Popcorn cell

Other name for L&H cell variant?

Moderately abundant

Cytoplasm of L&H variant?

CD15+, CD30+

Characteristic immunophenotype confirming classic Hodgkin lymphoma?

Very few RS cells

Proportion of RS cells vs inflammatory background?

Nodular sclerosis

Most common subtype of Hodgkin lymphoma?

65-70%

Percentage of HL cases that are nodular sclerosis?

Equal

Sex distribution of nodular sclerosis HL?

Cervical, supraclavicular, mediastinal

Common lymph node sites in nodular sclerosis HL?

Adolescents or young adults

Common patient age group?

Lacunar cell

RS variant typical of nodular sclerosis?

Rare

Association with EBV in nodular sclerosis?

Stage I or II

Common stages seen in nodular sclerosis HL?

Mediastinum

Most frequently involved region?

Excellent

Prognosis of nodular sclerosis HL?

CD15+, CD30+, CD45-

Immunophenotype of nodular sclerosis RS cells?

Collagen deposition

Morphologic feature dividing lymph nodes into nodules?

Uncommon

Frequency of diagnostic RS cells in nodular sclerosis?

20-25%

Percentage of HL cases that are mixed cellularity?

Male

Gender most affected in mixed cellularity HL?

70%

Association with EBV in mixed cellularity?

Older adults

Age group commonly affected?

Fever, night sweats, weight loss

Systemic symptom triad in mixed cellularity HL?

Good

Prognosis of mixed cellularity HL?

CD15+, CD30+, CD45-

RS immunophenotype of mixed cellularity HL?

T cells, eosinophils, plasma cels, macrophages

Histologic background cells in mixed cellularity HL?

Mononuclear RS

Common RS variant seen in mixed cellularity HL?

Uncommon

Frequency of lymphocyte-rich subtype?

40%

EBV association in lymphocyte-rich HL?

Older males

Sex and age predominance?

Excellent

Prognosis of lymphocyte-rich HL?

CD15+, CD30+, CD45-

RS phenotype in lymphocyte-rich HL?

Reactive lymphocytes

Predominant background cell type?

Mononuclear and diagnostic RS cells

Common RS variants found?

Lymphocyte depletion

Rarest subtype of Hodgkin lymphoma?

<5%

Percentage of lymphocyte depletion cases?

90%

EBV association in lymphocyte depletion HL?

Older males

Typical sex and age group?

Advanced disease

Clinical stage at presentation?

Poor

Prognosis of lymphocyte depletion HL?

CD15+, CD30+, CD45-

RS immunophenotype of lymphocyte depletion HL?

Pleomorphic RS cells

Morphology: abundance of RS cells and few lymphocytes?

Diffuse large B-cell lymphoma

Important differential diagnosis to rule out in lymphocyte depletion?

Nodular lymphocyte predominance

Type of Hodgkin lymphoma classified as non-classic?

Rare

EBV association of NLPHL?

Young males

Gender and age affected?

Cervical or axillary lymphadenopathy

Common presentation site?

Common

Recurrence in NLPHL?

Excellent

Prognosis of NLPHL?

L&H (popcorn) cell

RS cell variant seen in NLPHL?

CD20+, BCL6+, CD15-, CD30-

RS immunophenotype of NLPHL?

Nodules of small lymphocytes and macrophages

Morphologic hallmark of NLPHL nodes?

Scant or absent

Eosinophil and plasma cell presence in NLPHL?

Painless lymphadenopathy

Classic symptom of Hodgkin lymphoma?

Nodular sclerosis, lymphocyte predominance

Subtypes usually presenting at early stage?

Mixed cellularity, lymphocyte depletion

Subtypes with advanced, systemic disease?

Fever, night sweats, weight loss

Common systemic “B symptoms”?

Contiguous

Pattern of spread in Hodgkin lymphoma?

Single lymph node group

Initial site of involvement in most HL?

Nodal → splenic → hepatic → marrow

Sequence of spread of HL?

Ann Arbor

Staging system used in Hodgkin lymphoma?

Single lymph node region

Stage I HL description?

Two regions on same side of diaphragm

Stage II HL description?

Both sides of diaphragm

Stage III HL description?

Disseminated extranodal disease

Stage IV HL description?

S

Symbol for spleen involvement in staging?

E

Symbol for extranodal disease in staging?

B

Symbol for systemic symptoms in staging?

~90%

Cure rate of Stage I HL?

60-70%

5-year disease-free survival for Stage IV HL?

Tumor stage

Most important prognostic factor in HL?

Reed-Sternberg cell

Neoplastic cell type in Hodgkin lymphoma?

Reactive lymphocytes and macrophages

Background cells composing most of the tumor?

Classic and non-classic

Two broad types of Hodgkin lymphoma?

Nodular lymphocyte predominance

Example of non-classic HL?

Common

EBV association in classic HL?