Hodgkin's Disease

Prepare by Mr Wong Hoe Jiunn

6th year Group 3
Medical faculty
 Introduction
Hodgkin's lymphoma is an uncommon form of
cancer involving lymphatic tissue in the lymph
nodes and spleen
it is characterized by orderly spread from one lymph
node group to another and by the development
of systemic symptoms with advanced disease
The disease occurrence shows two peaks: the first in
young adulthood (age 15–35) and the second in
those over 55 years old
Etiology – Epstein-Barr virus
 Clinical Presentation
• Nontender lymph nodes enlargement ( localised )
– neck and supraclavicular area 60-80%
– mediastinal adenopathy 50%
– other ( abdominal, extranodal disease )
• systemic symptoms (B symptoms) 30%
– fever
– night sweats
– unexplained weight loss (10% per 6 months)
• other symptoms
– fatigue, weakness, pruritus
– cough , chest pain, shortness of breath, vena cava syndrome
– abdominal pain, bowel disturbances, ascites
– bone pain
 Pathologic Classification
WHO
• (Non-classical) Nodular lymphocyte
predominant Hodgkin's lymphoma (5 %)
• Classical Hodgkin's lymphoma
– Nodular sclerosing (60 - 80 %)
– Lymphocyte-rich (5 %)
– Mixed cellularity (15 - 30 %)
– Lymphocyte depleted (< 1 %)
Sternberg-Reed cell 

http://www.pathologyatlas.ro/reed-sternberg-cell.php
 Sternberg-Reed cell 

http://www.pathologyatlas.ro/reed-sternberg-cell.php
Lymphocyte predominant
High-power view
showing the
lymphocytic and/or
histiocytic (L&H)
type of cell
(‘popcorn’ cell) that
is characteristic of
this condition.

http://www.webpathology.com/image.asp?case=388&n=16
Lymphocyte-Predominant Hodgkin's
Lymphoma
This image shows a few L&H
cells (popcorn cells) in a
lymphocyte-rich
background. Classic Reed-
Sternberg cells are absent

http://www.webpathology.com/image.asp?
case=388&n=16
 Lymphocyte-Predominant Hodgkin's
Lymphoma

Low-power view showing a

mottled appearance of the node.

http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675(06)70334-5
 Nodular sclerosis
(Classical Hodgkin disease)
The conventional definition
of Hodgkin’s lymphoma
requires the presence of
Reed-Sternberg cells (many
are seen in this image) in a
characteristic background
infiltrate composed of
eosinophils, lymphocytes,
plasma cells, and histiocytes

http://www.webpathology.com/image.asp?case=388&n=4
http://commons.wikimedia.org/wiki/File:Reed-Sternberg_lymphocyte_nci-vol-7172-
300.jpg
 Gross appearance of lymph nodes involved by
Hodgkin's lymphoma. Note nodularity and
sclerosis.
http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675(06)70334-5
 Light micrograph of a section
through a lymph node affected by
nodular sclerosing pattern
Hodgkin's diseaseThis form results
in the deposition of irregular bands
of fibrous tissue and gives a
nodular appearance to the node. It
is associated with a good prognosis
if diagnosed at an early stage.

http://www.sciencephoto.com/images/download_lo_res.html?id=670036229
Mixed cellularity Hodgkin lymphoma
Mixed Cellularity type
accounts for 20% to 25%
of cases of Classical
Hodgkin’s Lymphoma.
Reed-Sternberg cells are
present in a background
of eosinophils, plasma
cells, lymphocytes, and
atypical mononuclear
cells. Fibrosis is usually
absent. 

http://www.webpathology.com/image.asp?case=388&n=11
Mixed cellularity Hodgkin lymphoma

CD30 expression in a case

of mixed cellularity
Hodgkin's lymphoma
(  240, alkaline
phosphatase-anti alkaline
phosphatase)

http://www.nature.com/modpathol/journal
Mixed cellularity Hodgkin lymphoma

Hodgkin's and Reed–

Sternberg cells with
strong Ki-67
expression in a case of
mixed cellularity
Hodgkin's lymphoma
(  480, streptavidin–
biotin complex)

http://www.nature.com/modpathol/journal
Lymphocyte Depletion Hodgkin Lymphoma

Necrosis is prominent in the center,

surrounded by many Reed-
Sternberg cells. Some cases of
lymphocyte depletion contain
swarms of very atypical cells,
sometimes sufficiently bizarre to
merit the label of "sarcomatoid".

http://pleiad.umdnj.edu/~dweiss/hd_types/ldhd_img.html
Lymphocyte Depletion Hodgkin Lymphoma

A Reed-Sternberg cell occupies

the center, surrounded by not-
too-many lymphocytes and
fibrosis that might be
described as disorganized.
When viewed through
polarized light, it is not
birefringent, unlike the fibrous
bands of nodular sclerosis.
http://pleiad.umdnj.edu/~dweiss/hd_types/ldhd_img.html
 Immunochemistry in Hodgkin lymphoma

Histopathologic
image of Hodgkin's
lymphoma. CD30
(Ki-1) immunostain.

http://commons.wikimedia.org/wiki/File:Hodgkin_lymphoma_(4)_CD30_immunostain.jpg
Undifferentiated malignancy.
H & E is shown in the top left corner.
This immunohistochemical stain is for CD20. This is a marker for B Cells (normal and
malignant). Note its location along cell membranes.
This information allows the medical onchologist or hematologist to add antibody therapy
directed against CD20 protein.

http://www.pathology-student.com/Gallery-immunohistochemistry.html
RS cells immunohistochemistry
There is a panel of
antibodies available
that helps identify RS
cells. CD15 and CD30
(CD30 here) are
commonly positive in RS
cells and can be useful
for helping make the
correct diagnosis.

http://www.pathology-student.com/Gallery-immunohistochemistry.html
 Staging
• Stage I disease in single lymph node or lymph node region.
 
• Stage II disease in two or more lymph node regions on  same 
side of diaphragm. 
 
• Stage III disease in lymph node regions on both sides of the 
diaphragm are affected. 
  
• Stage IV disease is wide spread, including multiple
involvement at 
one or more extranodal (sites such as the bone marrow).
http://www.lymphomation.org/about-details.htm