Hodgkin lymphoma
Hodgkin 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]
- "B symptoms":[2] 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.[3]
Hodgkin lymphoma subtypes
Types:[1]
- Classical HL (CHL) - ~95% of HL.
- Nodular lymphocyte-predominant HL (NLPHL) - ~5% of HL.
Classic HL
- Four types of classic HL (see below).
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)[4] - variant of RSC:
- Cells (relatively) small (compared to classic RSCs).
- Lobulated nucleus - key feature.
- Small nucleoli.
Image (NLPHL):
IHC
Abbreviated panel:[5]
- 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.[6]
Additional - for completeness:
- CD3 (T lymphocytes)
NLPHL IHC differs from the classical HL:[6]
- LCA +ve.
- CD20 +ve.
- CD10 +ve.
- Bcl-6 +ve.
- EMA +ve.
- CD30 -ve
- CD15 -ve.
"UHN panel"
| Antibody | NLPHL | CHL |
| CD45 | +ve | -ve |
| CD20 | +ve | -ve |
| BCL6 | ||
| MUM1[7] | -ve | |
| CD30 | -ve | +ve (most sensitive). |
| CD15 | -ve | +ve |
| CD21 | networks present | no networks |
| CD23 | networks present | no networks |
| OCT-2 | +ve | -ve |
| PAX5 | +ve | +ve (proves B cell linage) |
| CD3 | usu. < benign B cell | usu. > benign B cell component |
| CD57 | rosettes around malign. cells | - |
| EBER | -ve | +ve/-ve |
| EMA | +ve/-ve | -ve |
| 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.
- ↑ URL: http://lymphoma.about.com/od/symptoms/f/bsymptoms.htm. Accessed on: 11 August 2010.
- ↑ 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.
- ↑ 6.0 6.1 Lefkowitch, Jay H. (2006). Anatomic Pathology Board Review (1st ed.). Saunders. pp. 683. ISBN 978-1416025887.
- ↑ URL: http://www.ncbi.nlm.nih.gov/omim/601900. Accessed on: 10 August 2010.