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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.

Hodgkin's disease
  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.
  2. 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
  1. CD 15 positive:
  2. CD 30 positive
  3. CD 45 negative
Rare Reed Sternberg cells (Frequent lymphocytic and histocytic variants (Popcorn cells)
Characteristically different immunophenotype
  1. CD 15 negative
  2. CD 30 negative
  3. 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


  1. 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
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


Note: Hodgkin’s lymphoma is associated with prominent or pure paraneoplastic cerebellar degeneration.

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
Treatment of Hodgkin’s disease
1. Stage I (A) and stage II (A) 2. Stage III and stage IV and patient with group B symptoms
Corner stone of treatment is radiotherapy to
involved field
Cornerstone of treatment is combination chemotherapy
Regimen Agents Comments
(H-18th P-934)
  • First line treatment of choice
  • Most popular regimen in United States
  • More effective than MOPP
  • Higher incidence of Sterility but less secondary malignancies than MOPP
  • More satisfactory than MOPP and ABVD in alternating cycles or MOPP/ABV Hybrid
MOPP Mechlorethamine Vincristine Procarbazine Prednisolone
  • Less effective and more toxic than ABVD
  • Lesser incidence of sterility and higher secondary malignancies than
    AB VD
Stanford V
  • Doxorubicin - Bleomycin
  • Vinblastine - Mechlorethamine
  • Vincristine - Prednisolone
  • Etoposide + Radiotherapy
  • Excellent results but still under investigations / Trail


Extra Edge
Lymph node enlargement– Differential diagnosis includes a variety of infectious conditions like TB, neoplastic diseases such as lymphomas or metastatic carcinomas, and rare disorders like Kikuchi disease (necrotizing histiocytic lymphadenitis). Kimura’s disease and Castleman’s disease.

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