HODGKIN'S LYMPHOMA

It is a type of cancer that originates from a specific group  of white blood cells called B lymphocytes.It arises within lymph nodes and also involves extra-nodal lymph nodes secondarily. 

                                

                                     

Incidence

Hodgkin's disease had a bimodal distribution of age-specific incidence rates with two peaks in the age groups of 15-34 years and older than 55 years.

It is more prevalent in young adult males than in females.

                                           

Etiology

Its main etiology is from Ebstein barr virus(EBV). This virus causes increased production of the transcription factor NF-𝜿𝛃( responsible for proliferation) in the B cells and decreased production of I-𝜿𝛃 (responsible for inhibition of NF-𝜿𝛃) which ultimately leads to increased proliferation of cancer cells.

REED STEENBERG CELLS

• Presence of these cells is the classical feature of hodgkin lymphoma.
• These cells have 2 nuclei with prominent nucleoli.
• OWL EYE appearance of cells.
• They have CD15 and CD30 markers on their surface.
• Aneuploidy(more than normal number of copies) of 2p chromosome.

Variants of RS cell

Lacunar cell- it has all the features of a RS cell with a pericellular cytoplasm or lacuna in which it lies. This lacuna is formed by the artificial shrinkage of the cytoplasm .

It releases TGF-𝛃 responsible for deposition of fibrous tissue.

Polypoid type / lymphohistiocytic cell / popcorn cell

In this type the nucleus has irregular indentations.

CD15 and CD30 are absent.CD20 is present.

Pleomorphic RS cells

They have pleomorphic or atypical nuclei

                                        

Presence of RS cells along with inflammatory cells is considered as hodgkin's lymphoma . This is because in some conditions like infectious mononucleosis and immunoblastic lymphoma RS-like cells are found.

1. Nodular sclerosis classical HL 

•      It is the most common type of hodgkin's lymphoma in the world.
•      Equal incidence in males and females
•      It consists of lacunar type of reed steenberg cells. Because of these cells variable amount of fibrous tissue is present in the involved lymph node.

2.Mixed cellularity classical HL

• It is the most common type in India
• It consists of RS cells, plasma cells , eosinophils and lymphocytes.
• Some amount of fibrosis and focal area of necrosis is present in the lymph nodes.

3.Lymphocyte rich HL

•    It is seen in elderly individuals .
•    It consists on lymphohistiocytic cells .
•    Since there are more number of lymphocytes in this type this condition has a better prognosis.

4. Lymphocyte depleted HL

•      In this type of HL the lymph node is depleted of lymphocytes so it has the worst prognosis.
•     Atypical histiocytes called hodgkins cells are seen.

                             

Nodular lymphocyte predominant HL has the best prognosis.

Clinical features include:

Painless, rubbery lymph node enlargement, mostly cervical lymph nodes.

Other symptoms are fever,night sweats and weight loss.

   

STAGING