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 ClassificationWHO

• (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

http://www.webpathology.com/image.asp?case=388&n=16

High-power view showing the lymphocytic and/or histiocytic (L&H) type of cell (‘popcorn’ cell) that is characteristic of this condition.

Lymphocyte-Predominant Hodgkin's Lymphoma

http://www.webpathology.com/image.asp?case=388&n=16

This image shows a few L&H cells (popcorn cells) in a lymphocyte-rich background. Classic Reed-Sternberg cells are absent

Lymphocyte-Predominant Hodgkin's Lymphoma

http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675(06)70334-5

Low-power view showing a mottled appearance of the node.

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 immunohistochemistryThere 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