Hodgkin Lymphoma
Also written as NHL.
Variants of them called lacunar cells are also seen with some forms of Hodgkin lymphoma.
Treatment at a glance
- ABVD: doxorubicin, bleomycin, vinblastine, dacarbazine
Hodgkin Lymphoma
- Key concepts: Reed-Sternberg cells · Subtypes · Pathogenesis · Staging · Clinical features · Prognosis
- Hodgkin lymphoma is characterised by the presence of Reed-Sternberg (RS) giant cells — the neoplastic cell — which are typically vastly outnumbered by non-neoplastic inflammatory cells. Unlike most NHLs, it arises in a single lymph node or
- Reed-Sternberg cell morphology — very large cells (15–45 µm) with an enormous multilobate nucleus, exceptionally prominent nucleoli, and abundant slightly eosinophilic cytoplasm. The classic form has two mirror-image nuclear lobes each cont
- Origin of RS cells — long mysterious, but molecular studies on single microdissected RS cells showed every RS cell in a given case carries identical immunoglobulin gene rearrangements that have undergone somatic hypermutation → Hodgkin lymp
- EBV and pathogenesis — EBV is present in RS cells in up to 70% of mixed-cellularity cases and a smaller fraction of other classical subtypes. EBV genome integration is identical in all RS cells within a case, indicating infection precedes t
Read this in Hematologic Malignancies and Bleeding Disorders
Hodgkin Lymphoma
- Key concepts: Distinction from NHL · Reed-Sternberg cells · WHO classification · Spread pattern
- Hodgkin lymphoma is set apart from NHLs by the presence of distinctive Reed-Sternberg (RS) giant cells — the neoplastic cell. RS cells are typically vastly outnumbered by non-neoplastic inflammatory cells (lymphocytes, eosinophils, plasma c
- Key clinical distinction from NHL: Hodgkin lymphoma often arises at a single site and spreads in a predictable, contiguous fashion to adjacent lymph node groups → early-stage disease is sometimes treated with local radiotherapy alone. NHLs
- WHO classification of Hodgkin lymphoma:
- Reed-Sternberg cells — large cells with abundant cytoplasm and bilobed or multilobed nuclei each containing a huge inclusion-like nucleolus ( "owl-eye" appearance ). RS cells derive from germinal centre B cells — they have rearranged immuno
Read this in White Cell Disorders — Must-Know Notes
What our notes say
- Variants of them called lacunar cells are also seen with some forms of Hodgkin lymphoma. (hematopathology — Past Paper Questions & Answers)
- Though indolent, this kind of non-Hodgkin lymphoma is difficult to eradicate. (hematopathology — Past Paper Questions & Answers)
- A monoclonal antibody against CD20, a B cell surface antigen, is used for treatment of certain non-Hodgkin lymphomas (Oncopathology MCQs: Test Your Knowledge on Cancer Pathology)
- Non-Hodgkin lymphoma is the most common testicular tumor in men older than 60 (General Pathology MCQs: Fixatives, FNA, Endocrine & ARDS)
- RS cells are specific to Hodgkin lymphoma (A is false for NHL); NHL spreads non-contiguously (C false); NHL *can* have a leukaemic phase (D false); Ann Arbor staging is mainly used for Hodgkin lymphoma, though sometimes applied to NHL too — B remains the best answer. (Hematopathology MCQs & Essays: MBChB Exam Revision Guide)
- Write in very brief about Hodgkin's lymphoma andits (Second Professional) subtypes, 40 (Pathology Question Paper — Past Paper Questions & Answers)
Study material on Hodgkin Lymphoma
- Non-Hodgkin Lymphoma: Classification, Symptoms, Diagnosis, and Treatment
- White Cell Disorders — Must-Know Notes
- hematopathology
- Hematopathology MCQs & Essays: MBChB Exam Revision Guide
- Hematologic Malignancies and Bleeding Disorders
- Hematology MCQs
- Here are all 45 questions, complete with full stems, choices, and answers.
- Haematopathology MCQs: Blood Disorders & Anemia Explained
- Acute Leukaemia (AML/ALL) & WBC Disorders: Hematology Guide
- Lymphoma Overview and Classification
- Non-Hodgkin Lymphoma: Classification, Symptoms, Diagnosis, and Treatment — Practice Questions
- Non-Hodgkin Lymphoma: Classification, Symptoms, Diagnosis, and Treatment — Practice Questions
- Non-Hodgkin Lymphoma: Classification, Symptoms, Diagnosis, and Treatment — Practice Questions
- Non-Hodgkin Lymphoma: Classification, Symptoms, Diagnosis, and Treatment — Practice Questions
- Non-Hodgkin Lymphoma: Classification, Symptoms, Diagnosis, and Treatment — Practice Questions
- Non-Hodgkin Lymphoma: Classification, Symptoms, Diagnosis, and Treatment — Practice Questions
Practice questions on Hodgkin Lymphoma
A patient with Hodgkin lymphoma has disease on both sides of the diaphragm involving multiple lymph node groups and the spleen, with no systemic symptoms. What is his Ann Arbor stage and what does the absence of systemic symptoms signify?
- Stage II-A — disease on same side of diaphragm, no systemic symptoms
- Stage III-A — disease on both sides of diaphragm including spleen, no systemic symptoms
- Stage IV-B — disseminated disease with no systemic symptoms
- Stage III-B — disease on both sides of diaphragm with systemic symptoms
Answer: B. Stage III involves lymph node regions on both sides of the diaphragm; the S suffix denotes splenic involvement giving Stage IIIS. The suffix A indicates absence of systemic symptoms (fever, night sweats, unexplained >10% weight loss). Stage B would indicate presence of these symptoms. Stage IV requires disseminated extralymphatic organ involvement which is not described here. ---
What percentage of Non-Hodgkin Lymphomas are of B-cell origin?
- 70%
- 75%
- 85%
- 90%
Answer: C. NHL is 85% B-cell and 15% T/NK-cell origin. This is a foundational fact frequently tested. ---
A 45-year-old woman has had a 6-month history of recurrent fever, night sweats, and weight loss. She has cervical and mediastinal lymphadenopathy. Lymph node biopsy shows a nodular pattern with broad bands of collagen and scattered lacunar cells that are CD15+ and CD30+. Most likely subtype of Hodgkin lymphoma?
- Mixed cellularity
- Lymphocyte predominance
- Nodular sclerosis
- Lymphocyte depletion
Answer: C. Collagen bands + lacunar cells (RS cell variant) + mediastinal involvement in a young woman = nodular sclerosis Hodgkin lymphoma. The most common subtype, most often presenting in young women with mediastinal disease. ---
What percentage of Non-Hodgkin Lymphomas are of B-cell origin?
- 20-30%
- 50%
- 85-90%
- 99%
Answer: C. Approximately 85% to 90% of NHLs are of B-cell origin, with the remainder being T-cell or NK-cell lymphomas. ---
What is the incidence of Non-Hodgkin Lymphoma per 100,000 population?
- 1-2 per 100,000
- 15-20 per 100,000
- 50-60 per 100,000
- 100 per 100,000
Answer: B. The incidence of NHL is approximately 15-20 per 100,000, making it significantly more common than Hodgkin lymphoma. ---
Which of the following best describes the spread pattern of NHL compared to Hodgkin Lymphoma?
- NHL spreads predictably to contiguous nodes
- NHL spread is often non-contiguous and extranodal
- NHL never involves the bone marrow
- NHL always starts in the mediastinum
Answer: B. Unlike Hodgkin lymphoma, NHL often involves multiple non-contiguous lymph node stations and frequently involves extranodal sites (GI tract, skin, etc.). ---