Hodgkin lymphoma

Hodgkin lymphoma 

Updated: 07/03/2023

© Jun Wang, MD, PhD

General features
  • Usually nodal
  • Likely B cell origin
  •  Two large groups: classical or nodular lymphocyte predominant
  •  Classical Hodgkin lymphoma
Most common Hodgkin lymphoma
Most likely B cell origin
More common in HIV + population or history of infectious mononucleosis
Sub classification of classical Hodgkin lymphoma based on background morphology
  • Nodular lymphocyte predominant Hodgkin lymphoma
Uncommon
Probably follicular B cell origin
More common in men
Clinical presentations
  • Lymphadenopathy
  • B-type symptoms (fever, drenching night sweats, weight loss)
  • Other organ involvement: Spleen, liver, lung, bone marrow, etc
  • Classical Hodgkin lymphoma
Bimodal age distribution in developed country: 15-35, > 54
Usually lymph nodes: Most common cervical, can be seen in mediastinal, axillary and paraaotic lymph nodes
Rarely extranodal
  • Nodular lymphocyte predominant Hodgkin lymphoma
Indolent
Two age peaks: Children, 30-40
Usually young men with cervical or axillary adenopathy
Key risk factors
  • Classical Hodgkin lymphoma
Immunosuppression
Autoimmune disorders
Family history of Hodgkin lymphoma
Key pathogenesis
  • Classical Hodgkin lymphoma
EB virus
Abnormal activation of NF-kB
  • Nodular lymphocyte predominant Hodgkin lymphoma
Unclear
Key morphological features
  • Classical Hodgkin lymphoma
Reed-Sternberg cells: Binucleate or bilobed nucleus with large owl-eyed eosinophilic nucleoli; abundant cytoplasm
4 subtypes based on background morphology
  • Nodular lymphocyte predominant Hodgkin lymphoma
Nodular growth in a background of small lymphocytes
Scattered LP cells (Popcorn cells): Large lobulated nuclei with nucleoli
Markers
  • Classical Hodgkin lymphoma (RS cells)
Positive: CD15, CD30
Negative: CD45
  • Nodular lymphocyte predominant Hodgkin lymphoma(LP cells)
Positive: CD45, CD20
Negative: CD15, CD30
Genetic abnormalities
  • Classical Hodgkin lymphoma
IgH gene rearrangement without ongoing hypermutation
  • Nodular lymphocyte predominant Hodgkin lymphoma
IgH gene rearrangement with ongoing hypermutation

 Summary

Treatment
  • Classical Hodgkin lymphoma: chemotherapy, radiation therapy
  • Nodular lymphocytic predominant Hodgkin lymphoma: surgery, chemotherapy, radiation therapy


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