Tuesday, 25 November 2014

Hodgkin's lymphoma

HODGKIN'S LYMPHOMA

Most common lymph node affected - cervical lymph node.
WHO classification ( 2 types on the basis of Reed Sternberg cells)
A) CLASSICAL—(following 4 subtypes)
Best / most specific marker for classical RS cells - CD 30 (100% of classical HL). 
Other markers CD 15 ( 75-85% ), PAX 5.

2) NODULAR SCLEROSIS. 
• Most common HL (world)
• Mediastinal involvement most common in this HL.
• Male and female are equally affected ( other HL, males are more commonly affected)
• Lacunar reed Sternberg cells are seen (cytoplasmic lacuna formed due to tissue fixation artefact )
• “Collagen Bands” are forming nodules in Lymph nodes.

2) MIXED CELLULARITY
• Most common HL in India
• Maximum RS cells are seen.
3) LYMPHOCYTE DEPLETED.
• Least common type of HL
• RS cells (various names) ---pleomorphic / Mummified / necrobiotic
• Worst prognosis

4) LYMPHOCYTE RICH
• Minimum RS cells are seen.

B) LYMPHOCYTE PREDOMINANT

• Popcorn RS cells (or lympho - histiocytic (L&H ) RS cells )
• Immunophenotyping- CD 20 (=BCL6+ve), CD 45, CD 79a, EMA (Epithelial Membrane Antigen)
• Best prognosis amongst all HL.

‪#‎HIGH‬ yield info about HL:-

• EBV and HIV infections ,both are most commonly a/w(amongst Hodgkins lymphoma subtype)----MIXED CELLULARITY (HODGKINS LYMPHOMA)
• HIV associated Hodgkins Lymphomas are ----
mixed cellularity (most common)
nodular sclerosis and 
lymphocyte depleted
• EBV not associated with HL—
1) Nodular sclerosis
2) lymphocyte predominant

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