ЁЯУЪ

Hodgkin and Non-Hodgkin Lymphoma: Differences, Definitions, and Classifications

Jun 18, 2024

View transcript

Hodgkin and Non-Hodgkin Lymphoma: Differences, Definitions, and Classifications

Key Topics Covered

  • Differences between Hodgkin and Non-Hodgkin Lymphoma
  • Definition of Lymphoma
  • Classification of Hodgkin Lymphoma
  • Pathogenesis of Hodgkin Lymphoma
  • Reed-Sternberg cells and its variants
  • Subtypes of Hodgkin Lymphoma
  • Ann Arbor Classification
  • Clinical Features

Differences between Hodgkin and Non-Hodgkin Lymphoma

  1. Nodal Involvement:
  • Hodgkin: Single axial group of nodes (cervical, mediastinal, paraaortic).
    • Non-Hodgkin: Multiple nodes, non-contiguous spread.
  1. Nodal Spread:
  • Hodgkin: Orderly spread by continuity.
    • Non-Hodgkin: Non-contiguous spread.
  1. Involvement of Mesenteric Nodes and Waldeyer's Ring:
  • Hodgkin: Rarely involved.
    • Non-Hodgkin: Often involved.
  1. Extranodal Presentation:
  • Hodgkin: Rare.
    • Non-Hodgkin: Common.
  1. Age Distribution:
  • Hodgkin: Bimodal age distribution (20 years and elderly).
    • Non-Hodgkin: No specific age distribution.

Definition of Hodgkin Lymphoma

  • Involvement of a single axial group of nodes.
  • Spreads to anatomic contiguous lymphoid tissues.
  • Neoplastic disease with characteristic Reed-Sternberg (RS) cells.

Classification of Hodgkin Lymphoma

  1. Classical Hodgkin Lymphoma (CHL)
  • Nodular Sclerosis
    • Mixed Cellularity
    • Lymphocyte-Rich
    • Lymphocyte-Depleted
  1. Nodular Lymphocyte Predominant Hodgkin Lymphoma (NLPHL)
  • Different immunophenotype (CD15-, CD30-).

Pathogenesis of Hodgkin Lymphoma

  • Originates from germinal center or post-germinal center B-cells.
  • Two types: EBV-positive and EBV-negative tumor cells.
  • RS cells express LMP1 (EBV-positive) or lose function of TNFAIP3 (EBV-negative), leading to NF-kB activation which supports growth and survival.
  • Cross-talk between RS cells and surrounding reactive cells.

Reed-Sternberg Cells and Variants

  1. Classic RS Cell: Large with bi-lobed nucleus and prominent nucleoli ("owl-eye" appearance).
  2. Mononuclear RS Cell: Single nucleus with inclusion-like nucleolus.
  3. Lacunar Variant: Multilobed and folded nuclei, cytoplasm dissociation.
  4. L&H (Popcorn) Cells: Polylobate nucleus resembling popcorn.
  5. Pleomorphic or Anaplastic Variant: Atypical nuclei, associated with Lymphocyte Depleted subtype.

Subtypes of Hodgkin Lymphoma

  1. Nodular Sclerosis
  • Most common, lacunar variants, fibrous bands dividing cellular areas.
  1. Mixed Cellularity
  • Common, diagnostic RS cells with mixed inflammatory background, EBV-positive in 70% cases.
  1. Lymphocyte-Rich
  • Uncommon, T-lymphocytes background, EBV-associated in 40% cases.
  1. Lymphocyte-Depleted
  • Least common, worst prognosis, two variants: Diffuse Fibrosis and Reticular.

Non-classical Type: NLPHL

  • More favorable prognosis, prominent L&H cells.
  • CD20+, CD45+, EBV-negative.

Ann Arbor Classification

  1. Stage I: Single lymph node region or extralymphatic organ/site.
  2. Stage II: Two or more lymph node regions on the same side of diaphragm.
  3. Stage III: Lymph node regions on both sides of diaphragm.
  4. Stage IV: Dissemination to extranodal sites.

Clinical Features

  • Main presentation: painless lymphadenopathy
  • B symptoms: fever, night sweats, weight loss (if advanced stage).
  • Spread: From lymph nodes to spleen, liver, bone marrow, and other organs.

Conclusion

  • Hodgkin Lymphoma has distinct features and treatment responses compared to Non-Hodgkin Lymphoma.
  • Understanding classifications, pathogenesis, and clinical features are crucial for diagnosis and treatment.

[Video Link for more information]

Thank you!

Full transcript