Difference between revisions of "Hodgkin lymphoma"
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*CD15 -ve. | *CD15 -ve. | ||
===UHN panel=== | ==="UHN panel"=== | ||
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*CD20 -- +ve in NLPHL. | *CD20 -- +ve in NLPHL. | ||
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*CD30 -- +ve in CHL. | *CD30 -- +ve in CHL. | ||
*CD15 -- +ve in CHL. | *CD15 -- +ve in CHL. | ||
*CD21. | *CD21 -- +ve in HLPHL. | ||
*CD23. | *CD23. | ||
*OCT-2 -- +ve NLPHL, -ve CHL. | *OCT-2 -- +ve NLPHL, -ve CHL. | ||
*PAX5. | *PAX5 -- prove B cell linage in CHL. | ||
*CD3. | *CD3. | ||
Revision as of 16:27, 10 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]
Hodgkin lymphoma subtypes
Types:[1]
- Classical HL (CHL) - ~95% of HL.
- Nodular lymphocyte-predominant HL (NLPHL) - ~5% of HL.
Classic HL
- See microscopic for subtypes of CHL.
NLPHL
- AKA lympho-histiocytic variant.
- Abbreviated NLPHL.
- Different IHC and morphologic appearance than classic HL.
Microscopic
By definition, HL has Reed-Sternberg cells (RSCs).
Classical HL
Features (classic HL):
- Reed-Sternberg cell.
- Large binucleated cell.
- Macronucleolus - approximately the size of a RBC (~8 micrometers).
- Well-defined cell border.
Images (classic HL):
- HL mixed cellularity - cytology (WC).
- HL mixed cellularity - cytology (WC).
- HL mixed cellularity (WC).
Subtypes
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
Features (nodular lymphocyte-predominant Hodgkin's lymphoma):
- Lymphocytic & histiocytic cell (L&H cell)[3] - variant of RSC:
- Cells (relatively) small (compared to classic RSCs).
- Lobulated nucleus - key feature.
- Small nucleoli.
Image (NLPHL):
IHC
Abbreviated panel:[4]
- 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.[5]
Additional - for completeness:
- CD3 (T lymphocytes)
NLPHL IHC differs from the classical HL:[5]
- LCA +ve.
- CD20 +ve.
- CD10 +ve.
- Bcl-6 +ve.
- EMA +ve.
- CD30 -ve
- CD15 -ve.
"UHN panel"
- CD45 -- +ve in NLPHL.
- CD20 -- +ve in NLPHL.
- BCL-6.
- MUM1 -- -ve in NLPHL.
- CD30 -- +ve in CHL.
- CD15 -- +ve in CHL.
- CD21 -- +ve in HLPHL.
- CD23.
- OCT-2 -- +ve NLPHL, -ve CHL.
- PAX5 -- prove B cell linage in CHL.
- CD3.
- CD57 -- increased in NLPHL.
- EBER.
- EMA.
- 4 unstained.
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.
- ↑ PMID: 9499174
- ↑ 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.
- ↑ 5.0 5.1 Lefkowitch, Jay H. (2006). Anatomic Pathology Board Review (1st ed.). Saunders. pp. 683. ISBN 978-1416025887.