hodgkins lymphoma pathology

what is the key to prognosis & treatment wih hodgkins lymphoma?
staging (rather than what kind of cell)
do both hodgkins and non-hodgkins lymphomas have systemic symptoms?
yes, though hodgkins has a little more prominent presentation of fever/night sweats
what do hodgkin lymphomas tend to involve?
lymph nodes as opposed to extra-nodal sites (single or chain of lymph nodes in contigous fashion)
what characterizes hodgkin disease?
the reed-sternberg cell which is a neoplastic giant cell. it has a multilobate nucleus or it is multinucleate with large nucleoli. its origins are unknown and it may be associated with EBV
how do hodgkin lymph nodes appear grossly?
lumpy bumpy w/follicles bulging out
what are the 4 different types of hodgkin disease?
lymphocyte predominance, mixed cellularity, lymphocyte depletion, and nodular sclerosis
how do reed sternberg cells look?
“googly eyes” – may have one nucleus, have clear areas surrounding nucleus, others w/HUGE nuclei
what are characteristics of lymphocyte predominant classic hodgkins lymphoma?
it has a large number of lymphocytes mixed with histiocytes (tissue macrophages). it has “popcorn cells” – reed sternberg variants with multilobed, puffy nuclei. it resembles follicular NHL in shape and has the best prognosis of the 4 subtypes. (with RSC’s, you will often see considerable cell pleiomorphism with any classical HL subtype, so look for the most abundant RSC present)
what is characteristic about mixed-cellularity hodgkins disease?
it is the most common in pts over 50 (males > females), reed-sternberg cells are plentiful, there is heterogenous cellular infiltrate and it presents more often with disseminated disease
what is characteristic about lymphocyte depletion hodgkin’s disease?
it is the least common form of HD, it has few lymphocytes and an abundance of reed-sternberg cells. most pts with this are older and have disseminated disease
what are characteristics about nodular sclerosis HD?
is is the most common form of HD. it has lacunar cells (reed sternberg variants with multiple hyperlobate nuclei, surrounded by clear spaces. collagen bands divide the lymphoid tissue into nodules (fibrosis – firm)
who does nodular sclerosis hodgkin’s disease occur to? where anatomically?
nodular sclerosis HD occurs more often in adolescent/young adults and women, it in cervical, supraclavicular and mediastinal lymph nodes (it can lead to coughing- recurrent laryngeal nerve or superior vena cava syndrome where blood can’t return to the heart, swelling to head)). it has an excellent prognosis
what impact does the histological dimension of hodgkin’s have on it’s clinical course?
very little in comparison to staging
what is clinical staging for hodgkin disease?
how far the disease has spread throughout the body
what treatments are generally successful for pts with hodgkin disease?
chemo and radiotherapy are usually successful, but can increase risk of malignancies down the road
what is stage I hodgkins disease?
a single lymph node or extralymphatic organ/site affected
what is stage II hodgkins disease?
2+ lymph nodes on the same side of the diaphragm or localized involvement of an extralymphatic origin
what is stage III hodgkins disease?
lymph region involvement on *both sides of the diaphragm OR localized involvement of an extralymphatic origin OR spleen OR both
what is stage IV hodgkins disease?
diffuse/disseminated involvement of 1+ extra lymphatic organs OR w/associated lymph node involvment
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