Difference between revisions of "Hodgkin lymphoma"
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==See also== | ==See also== | ||
*[[Lymph nodes]]. | *[[Lymph nodes]]. | ||
*[[Lymph node pathology]] | *[[Lymph node pathology]]. | ||
*[[Haematopathology]]. | *[[Haematopathology]]. | ||
Revision as of 12:49, 4 August 2010
Hodgkin's lymphoma, abbreviated HL, is a malignancy that afflicts people in the prime of their life. Fortunately, it usually has a good prognosis.
Pathologists say "... it is both the easiest and hardest diagnosis to make." The reason for this is: the diagnosis depends on finding Reed-Sternberg cells; if they are obvious the diagnosis is easy... if you can't find 'em and an alternative diagnosis is not apparent -- you wonder whether you're missing them.
Clinical
Symptoms:[1]
- Fever, night sweats, weight loss.
- Infections (due to immune dysfunction).
Diagnosis:
- HL cannot be diagnosed with standard flow cytometry (FC) - but has been diagnosed with specialized FC.[2]
Microscopic
Features:
- Reed-Sternberg cell (by definition).
- Large binucleated cell.
- Macronucleolus - approximately the size of a RBC (~8 micrometers).
- Well-defined cell border.
HL subtypes
Types:[1]
- Classical HL (CHL) - ~95% of HL.
- Nodular lymphocyte-predominant HL (NLPHL) - ~5% of HL.
Classical HL
There are four CHL subtypes:[1]
- Nodular sclerosis CHL - ~70% of CHL.
- Mixed cellular background - T cell, plasma cells, eosinophils, neutrophils and histiocytes.
- Nodular sclerosing fibrosis - thick strands fibrosis.
- Mixed cellularity CHL - ~20-25% of CHL.
- Like nodular sclerosis - but no fibrosis.
- Lymphocyte-rich CHL - rare.
- T lymphocytes only (no mix of cells).
- Lymphocyte-depleted CHL - rare.
- Assoc. with HIV infection.
Memory device:
- The subtypes prevalence is in reverse alphabetical order.
Nodular lymphocyte-predominant HL
- AKA lympho-histiocytic variant.
Features:
- The diagnostic cells in this variant: relatively small, lobulated nucleus, small nucleoli.
Image:
IHC
Abbreviated panel:[3]
- CD30 Reed-Sternberg cells (RSCs) +ve ~98%
- CD15 Reed-Sternberg cells +ve ~80%, stains neutrophils.
- CD45 often negative in RSCs.
- CD20 may stain RSCs.
- PAX5 +ve.[4]
Additional - for completeness:
- CD3 (T lymphocytes)
NLPHL IHC differs from the classical HL:[4]
- LCA +ve.
- CD20 +ve.
- CD10 +ve.
- Bcl-6 +ve.
- EMA +ve.
- CD30 -ve
- CD15 -ve.
See also
References
- ↑ 1.0 1.1 1.2 Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 567. ISBN 978-0781765275.
- ↑ Fromm JR, Thomas A, Wood BL (March 2009). "Flow cytometry can diagnose classical hodgkin lymphoma in lymph nodes with high sensitivity and specificity". Am. J. Clin. Pathol. 131 (3): 322–32. doi:10.1309/AJCPW3UN9DYLDSPB. PMID 19228638.
- ↑ Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 568. ISBN 978-0781765275.
- ↑ 4.0 4.1 Lefkowitch, Jay H. (2006). Anatomic Pathology Board Review (1st ed.). Saunders. pp. 683. ISBN 978-1416025887.