Classical Hodgkin


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  • Clinical

    • 95% of all Hodgkins
    • bimodal age peaks 15-35, then elderly
    • associations: mono
    • site: cervical nodes (75%), other nodes, mediastinal involvement (60%), splenic involvement (20%)
    • stains and molecular same across all subtypes

  • Histology

    • Mononuclear Hodgkin cells
    • Reed Sternberg cells
      • large, resembles CMV
      • at least 2 nuclei or lobes
      • prominent nucleoli
      • pale chromatin
    • Mummified cells
      • pyknotic reddish nuclei
      • condensed cytoplasm
    • Background mixed inflammatory cells

  • Subtypes

    • nodular sclerosing
      • 70% of classical Hodgkins
      • nodules surrounded by thick collagen
      • lacunar cells (artifact causing clearing around Hodgkin cells)
      • background eosinophils and histiocytes
    • lymphocyte rich
      • 5% of classical Hodgkins
      • nodular with germinal centers (CD21), rarely diffuse
      • no fibrosis, PMNs or eosinophils
      • RS cells are rarer, NLP-like, and found in mantle zones
    • mixed cellularity
      • 20% of classical Hodgkins
      • diffuse, background eosinophils
      • most association with EBV
      • doesn't fit other types
    • lymphocyte depleted
      • <1% of classical Hodgkins
      • HIV association, prefers retroperitoneal nodes
      • diffuse +/- fibroblasts
      • predominance of Reed Sternberg cells
      • paucity of lymphocytes, lack eosinophils

  • Stains

    • Stain Reed Sternbergs
    • positive: CD30, CD15, weak PAX5
    • negative: CD20 (or weak), CD45, J chain, CD75, macrophage markers, CD138
    • EBV variable, high in 3rd world
    • CD30 normally stains grans, plasma cells, activated lymphs, NKs, monos
    • CD15 normally stains myeloid cells, eos, activated lymphs

  • Molecular

    • same across subtypes
    • clonal IG rearrangement
    • NFkB activation -> JAK/STAT
    • cytokine causes inflammatory cells
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