H.L is one of the most important tumors, more information, diagnosis, etc include in this presentation

1. Lecture 9
Developed by - Dr.Abdulrazzaq Othman Alagbare – MD-MCP- Lecturer of hematology &
Immunohematology

2. Topic
Pediatric
Hodgkin
lymphoma
hl
• Classic Hodgkin Lymphoma -CHL
• Nodular lymphocyte-predominant HL-NLPHL

3. Malignant Lymphomas-Definition
 Lymphomas are a heterogeneous group of malignant neoplasms,
which originate primarily in lymph nodes or other lymphoid tissues.
They are divided into two major types—
 Hodgkin’s lymphoma (HL)
 and Non-Hodgkin’s lymphoma (NHL).

4. Lymphoid Neoplasm -Cells
 Lymphoid neoplasm Included the mature lymphocytic cells
(B and T/NK) , lymphoid cells usually present as tumor of
 lymphnodes (lymphadenopathy)
 or related organs (e.g. spleen, liver and other solid
tissues).

5. Malignant Lymphomas -Terms
• Nodal: Lymphomas arising in the lymphnodes
• Extranodal lymphomas :lymphoma arising and existing in
the lymphoid related organs (e.g. skin, stomach or brain)

6. Classical Pediatric Hodgkin
lymphoma

7. 1832 1893
1902

8. They are CD15 and CD30 negative

9. Hodgkin lymphoma
 It is the primary malignant tumor of the lymph nodes and rarely
affect extra lymph node, lymphoid tissue.
The most important are tow types
1-Classic Hodgkin Lymphoma - CHL
2-Nodular Lymphocyte-Predominant Hodgkin Lymphoma -
NLPHL
These two types differ in
 clinical features, behavior, morphology and immunophenotype

10. HL-Risk factors
 EBV: especially Young adults,
 Genetic factors.
 Immune status:
 HL seems to be more frequent in immunocompromised
patients or those with autoimmune diseases, such as
rheumatoid arthritis.

11. Classical Hodgkin Lymphoma
Children
General info
 Belong to the mature B-lymphocyte lymphoma
 B-cell that has lost its ability to produce Igs
 Presence of Hodgkin/Reed-Sternberg (HRS) cell is the characteristic of
this malignant
 is usually localized to a single lymph node region in the initial stage;
 spread is in contiguous manner
 bone marrow involvement is rare.
 Incidence: Age:0-15 yrs

12. Adult Hodgkin Lymphoma- HL
 HL is a common form of malignancy in young adults (20-30 years).
 A second minor peak of increased incidence is noted after 50 years of age.
 Males are more commonly affected.

13.  HRS cells invade lymph nodes
 HRS cells comprise only 1% of
the tumor and 99% non-
malignant cells (immune cells,
small lymphocyte, macrophages,
plasma cells, eosinophils,
neutrophils, and fibroblasts)
Hodgkin/Reed-Sternberg (HRS) cells
What type of cell is the HRS?
 Recent molecular studies have shown that RS cell is a B lymphocyte

14.  HRS secrète many
cytokines and
chemokines, which attract
other immune cells to the
tumor microenvironment
(consist 99% of cells within
the tumor)
Hodgkin/Reed-Sternberg (HRS) cells -activity

15. Histological Variants of Reed-Sternberg Cell (RSC):
 There many subtypes of classic Hodgkin lymphoma with
CD15+ Reed-Sternberg cells and variants:
nodular sclerosis HL

16. Classic RS cells

17. Lugano classification
The usual mode of presentation is localized supra
diaphragmatic lymph node enlargement, commonly in
cervical region

18. Each stage is again subdivided into
A or B as follows
A: No systemic symptoms
B: Presence of systemic symptoms:
 Unexplained fever,
 Night sweats,
 Weight loss >10% in last 6
month

19. A- SYMPTOMS -enlarged nodes are  firm, painless, rubbery,
freely mobile,

20. B -symptoms and include:
fever, night sweats, and weight loss >10% in last 6 months
unfavorable prognosis

21. 1-History and physical examination:
2-Blood examination (CBC,LFT,RFT etc),
3-Fine Needle Aspiration Cytology (FNAC)
4-Bone marrow biopsy:
5-liver biopsy- in all patients with stage III disease
6-flow cytometry study for CD15,CD30
7-Radiological examination: X-ray-chest , PET/CT scan
positron emission tomography -PET
Hodgkin lymphoma – Diagnosis procedure

22. Hodgkin lymphoma –CBC
-Mild anemia
-Leukocyosis-eosinophilia is frequent
-Platelets :normal
-ESR: usually raised
Fine Needle Aspiration Cytology (FNAC)
 FNAC of the involved lymphnode shows RS cells/its variants against
a background of inflammatory cells (depending on the subtype).

23. Hodgkin lymphoma Hstological
diagnosis
 presence of RS cells in the
typical background of normal
inflammatory cells is
essential.
 accuracy of staging decides
the nature of treatment and
prognosis in HL.

24. Immunophenotyping for CHL
Diagnostically useful antigens in CHL include
The RS cells show
 CD30, and CD15 which is strongly positive in RS cells
 Negative for CD45 and T cell markers.
and EBV negative

25. Nodular Lymphocyte-
Predominant Hodgkin Lymphoma
- NLPHL

26. Definition : is a monoclonal B cell neoplasm
characterized by
 a nodular
 or a nodular and diffuse proliferation
of scattered neoplastic cells known as
popcorn or lymphocyte predominant
cells (LP cells).
 CONSIST about 5% of all Hodgkin
lymphomas.
 Incidence in children and adults
 NLPHL is not associated with EBV
infection.
Nodular Lymphocyte-Predominant Hodgkin Lymphoma - NLPHL

27. NLPHL-Diagnosis
 Diagnosis needs the presence of
large neoplastic lymphocytes
termed LP cells (Lymphocyte
predominant)
 and a host response rich in
small lymphocytes and
macrophages.
HRS cells difficult to find in this
subtype

28. NLPHL -Course
 Children with NLPHL present with a
more indolent course than classic
HL and are managed differently
than classic HL.
 Patients with limited-stage I
disease undergo surgery and are
subsequently observed if complete
resection has been achieved.

29. Immunophenotyping diagnosis for NLPHL
Diagnostically useful antigens in NLPHL include
RS cells are
 CD20+, CD 45+ indicate B cells
 and CD15–, C30– and EBV negative.