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Hodgkin's Lymphoma Overview

Aug 15, 2025

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Overview

This lecture covers Hodgkin's lymphoma, highlighting its characteristics, subtypes, clinical features, risk factors, and pathology.

Hematological Malignancies Overview

  • Hematological malignancies include leukemias, lymphomas, and myeloma.
  • Lymphoma is a solid tumor of lymphatic tissue such as lymph nodes and spleen.
  • Lymphomas are divided into Hodgkin's lymphoma (HL) and non-Hodgkin's lymphoma (NHL).

Hodgkin's Lymphoma: Epidemiology and Risk Factors

  • HL is less common but has a better prognosis than NHL.
  • Represents 40% of adult lymphomas.
  • More common in males, except nodular sclerosing subtype (more common in females).
  • Higher incidence in Caucasians and bimodal age distribution (peaks at 15-34 and >50 years).
  • Associated with HIV, Epstein Barr Virus (EBV), prior mononucleosis, benzene exposure, and defect in cell-mediated immunity.

Hodgkin's Lymphoma: Clinical Features

  • Presents with painless, localized cervical lymphadenopathy; supraclavicular and mediastinal nodes are also common sites.
  • Contiguous spread from one lymph node to the next, unlike distant spread in NHL.
  • Symptoms: cyclical fevers (Pel-Ebstein fever), pruritus (itching), splenomegaly (not massive), nephrotic syndrome (especially minimal change disease), obstructive jaundice, and possible autoimmune hemolytic anemia.
  • Alcohol-induced lymph node pain is specific for HL.

Subtypes and Prognosis

  • Two main classifications: nodular lymphocyte predominance (5%, good prognosis), and classic HL (most common).
  • Classic HL subtypes:
    • Nodular sclerosis (most common, best prognosis, females and children)
    • Lymphocyte-rich (very good prognosis)
    • Mixed cellularity (elderly, abdominal nodes/spleen, intermediate prognosis)
    • Lymphocyte-depleted (worst prognosis, most aggressive, least common)
  • Classic HL is associated with Reed-Sternberg cells.

Pathological and Diagnostic Features

  • Diagnosis requires a core needle biopsy (not fine needle aspiration).
  • Lymph nodes appear rubbery and "bulging fish flesh."
  • Microscopically, Reed-Sternberg cells are seen (CD15+ and CD30+).
  • Nodular sclerosis subtype features lacunar-type Reed-Sternberg cells.

Complications and Additional Notes

  • Secondary amyloidosis (serum amyloid A protein involvement) can occur.
  • Radiation treatment for HL can increase risk of developing NHL.
  • EBV can also cause other cancers (e.g., Burkitt's lymphoma, nasopharyngeal carcinoma).

Key Terms & Definitions

  • Hodgkin's lymphoma — malignancy of lymphatic tissue featuring Reed-Sternberg cells and local, contiguous spread.
  • Reed-Sternberg cell — giant, abnormal B lymphocyte pathognomonic for HL, CD15+ and CD30+.
  • Pel-Ebstein fever — cyclical fever pattern seen in HL.
  • Nodular sclerosis — most common HL subtype, excellent prognosis, more frequent in females.
  • Lymphadenopathy — disease or swelling of lymph nodes.

Action Items / Next Steps

  • Review diagnostic procedures and treatment options for Hodgkin's lymphoma in the next lecture.
  • Study subtype characteristics and associated prognoses for exam preparation.

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