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Lymphoma are disorder of malignant proliferation of lymphocyte. They accumulate in lymph node and cause lymphadenopathy.   They are also found in PBF and may infiltrate many other organs.
  1. Incidence. This neoplasm has a characteristic bimodal age distribution.
  1. A young adult peak occurs between the ages of 10 and 25 years and is character­ized by equal incidence in men and women, a preponderance of nodular scle­rosis pathology, and a more benign clinical course.
  2. A second adult peak occurs after age 50 years and is characterized by high inci­dence among men, a preponderance of mixed cellularity, and a more aggressive clinical course.
  1. Pathology. There are four major histologic variants of Hodgkin's disease.
Hodgkin’s disease
Classical Hodgkin’s disease Histogenetically distinct subtype of Hodgkin’s disease
Variants/ subtypes Variant / subtype
Mixed cellularity, Nodular sclerosis,
Lymphocyte Rich, Lymphocyte depletion
Lymphocyte predominant (Nodular lymphocyte predominant)
Characterized by Characterized by
Frequent Reed Sternberg cells
Characteristic immunophenotype
        i. CD 15 positive:         ii. CD 30 positive
        iii. CD 45 negative
Rare Reed Sternberg cells (Frequent lymphocytic and histocytic variants (Popcorn cells)
Characteristically different immunophenotype
        i. CD 15 negative          ii. CD 30 negative
        iii. CD 45 positive

1. Lymphocytic predominant is a distinct subtype.                   
2.  Most common in India is mix cellularity
3. Most common in world is nodular sclerosing                            
4. Classical marker is Hodgkin’s disease are CD15, CD30

(C). Clinical features and staging. Hodgkin's disease tends to spread in an orderly fashion from node group to node group. This contiguous nature is in marked contrast to non ­Hodgkin's lymphomas, which are multicentric early in their development. Pal Epstein fever occurs. There is pain less rubbery enlargement of lymph node occur. Alcohol causes increase in symptom (PGI Dec 2008).

 Important points:
  1. CNS involvement in Hodgkin’s is uncommon feature
  2. Reed stern berg cell is the characteristic cell in Hodgkin’s
  3. Plasma cells, eosinophils and neutrophils are seen in the reactive background
  4. Mediastinal involvement is particularly common with nodular sclerosis variant.
Certain distinctive features seen in nodular sclerosis variant
  1. It is the most common variant
  2. It is the only variant more common in females.
  3. Mediastinal involvement is particularly common
  4. Large reed Sternberg cell variants – Lacunar cells – are present on histology.
  5. It has a good prognosis [2nd best, following Lymphocyte predominance (best)] (LQ 2012)
Hodgkin’s lymphoma Immuno pheno type Association with EBV Read Sternberg cell variant
Nodular sclerosis CD15 + , CD30+ EBV - Ve Lacunar cells (occasional R-S-cells)
Mixed cellularity CD15 + , CD30+ EBV + Ve (70%) Classic reed Sternberg cells
Lymphocyte depletion CD15 + , CD30+ EBV + Ve Reticular variant (Frequent R-S cells)
WORST prognosis
Lymphocyte predominance CD15 -ve , CD30 –ve
CD20 +ve , CD45 +ve
EBV – Ve Popcorn cell variant
BEST prognosis

1.    The modified Ann Arbor classification
 Stage                   Characteristics
   I                            Involvement of a single lymph node region or a single extralymphatic site                                                                      
   II                           Involvement of two or more lymph node regions on the same side of `the diaphragm                                     
   III                          Involvement of two or more lymph node regions on both sides of the diaphragm                                      
   III1                        Involvement limited to the lymphatic structures in the upper abdomen (i.e.) spleen or splenic, celiac, or hepatic portal nodes)
   III2                        Involvement of lower abdominal nodes (i.e., para-aortic, iliac, or mesenteric
nodes); possible involvement of the splenic, celiac, or hepatic portal nodes as well
   IV                          Diffuse or disseminated involvement in extralymphatic organs
                                Sub classifications
A                         Asymptomatic
 B                          Unexplained loss of 10% of body weight; unexplained fever of greater
                                Than 38°C; night sweats

Paraneoplastic cerebellar degeneration
  1. Pure paraneoplastic cerebellar degeneration:
    1. Breast & Gynecological cancer (Anti Yo antibodies)
    2. Hodgkin’s lymphoma (Anti Tr antibodies)
  2. Subacute cerebellar degeneration
    1. Small cell carcinoma lung  
    2. Thymoma  
    3. Neuroblastoma
  3. The adverse prognostic factors identified in the international study are:
    1. Age ≥ 45 years                                                        
    2. Stage IV disease
    3. Hemoglobin < 10.5 g/%                                         
    4. Lymphocyte count < 600/ml or < 8% of WBC
    5. Male gender                                                            
    6. Albumin < 4.0 g/%                                        
    7. White blood count ≥ 15,000/ml
  4. Additional poor prognostic factors are:
    1. Lymphocyte depletion subtype                           
    2. Presence of mediastinal disease             
    3. Systemic manifestation

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