This document discusses the different subtypes of Hodgkin's lymphoma. It notes that Hodgkin's lymphoma is typically localized with orderly spread through contiguous lymph nodes, while non-Hodgkin's lymphoma can spread non-contiguously. The main subtypes discussed are nodular sclerosis, mixed cellularity, lymphocyte depletion, and lymphocyte rich, along with their characteristics such as associated Epstein-Barr virus presence, patient demographics, histological features, and prognosis.

1. HODGKINS NON-HODGKINS
OFTEN LOCALIZED
LESION
MULTIPLE NODES
ORDERLY SPREAD NONCONTIGUOUS
SPREAD
RARE – WALDEYER/
MESENTERIC NODES
COMMON
UNCOMMON
EXTRANODAL
COMMON
EXTRANODAL

3.  Reed-Sternberg present
◦ Derived from germinal center or post germinal
center B cells
 Background of Reactive Inflammatory
Cells of Various types
 Variable Fibrosis
* LACK THE MONOMORPHIC
APPEARANCE OF OTHER LYMPHOMA

5.  Account for 0.7% of new Ca in USA
 Arise in a Single or Chains of LN
 Most common Malignancy in YOUNG
ADULTS ( 32y/o)
 Curable in most cases
 May progress to NHL or Leukemia
◦ spontaneously or after Tx.

6.  Unknown
 EBV plays a role  50% present in
R-S cells (Mixed Cellularity)
 High incidence  Hx of IM
 Genetic Susceptibility

7.  EBV (+) RS EXPRESS LATENT
MEMBRANE PROTEIN-1
◦ PROTEIN ENCODED BY EBV
◦ HAS TRANSFORMING ACTIVITY
◦ UPREGULATES NF- Kb
 EBV (-) RS cells
◦ ACQUIRED MUTATION OF NEGATIVE
REGULATOR OF NF-kB

8.  ACTIVATION OF NF-kB RESCUES
DOOMED CELLS FROM APOPTOSIS
 RS cell PRODUCE CYTOKINE 
ACCUM. REACTIVE CELLS  SUPPORT
GROWTH & SURVIVAL OF TUMOR
CELLS
◦ IL-5, IL-6, IL-13 ,TNF

9. Predictable
Spread 1st to Contiguous
Nodes
◦Nodal Disease First  Spleen
 Liver  BM  Extranodal

10.  Soft to hard , large Lymph Node
 Nodularity common in Nodular
Sclerosis
 Foci of necrosis +
 Heterogenous c/s except for
LYMPHOCYTE PREDOMINANCE
 Matted L.N. in Advanced cases

11.  PAINLESS LYMPHADENOPATHY
 PAIN INVOLVED L.N. W/ ALCOHOL
◦ Paraneoplastic Symptom
 CUTANEOUS ANERGY
◦ Depressed Cellular immunity
 IMMUNE DYSFUNCTION
◦ UNKNOWN, PERSIST AFTER Tx.
 INCREASED RISK FOR 2ND CANCERS
◦ AML, BREAST Ca GASTRIC Ca
 Limited Disease is Cured w/ Local
RadioTx

12. STAGE CRITERIA
I In one lymph node only
II In 2 or more LN on same side of the diaphragm
III In the Lymph nodes, Spleen, or Both AND on Both
sides of the diaphragm
1 Above the renal vessels (eg. Spleen, splenic, hilar,
celiac, portal nodes
2 In the lower abdomen ( periaortic, pelvic, or
imguinal nodes )
IV Extranodal involvement ( eg. Bone marrow, Lung,
Liver )
A – absence of Systemic manifestation
B – presence of Systemic manifestation
NIGHT SWEATS, FEVER, WEIGHT LOSS

13. Stage I or II Stage III or IV
Systemic
s/s
Usually
absent
Usually
present
Type Nodular
sclerosis
MC or LD
5 year
disease
free
90% 60-70%
Systemic manifestation:
NIGHT SWEATS, FEVER, WEIGHT LOSS

14.  Tumor stage is most important Prognostic
Variable
◦ Not Histologic Type
◦ R/T to current Tx protocols
 Long term survivors of ChemoTx and RadioTx
◦ Increased risk fro secondary Ca
◦ Breast Ca common in:
 Females Tx w/ RadioTx to chest during adolescence
◦ AML/ Myelodysplastic syndrome common
 ChemoTx

16.  MOST COMMON 65-70%
 MALE = FEMALES
 ADOLESCENT & YOUNG
ADULTS
 EXCELLENT PROGNOSIS

17.  Stage 1 or 2
 LOWER CERVICAL ,
SUPRACLAVICULAR &
MEDIASTINAL L.N.
 RARELY ASSOC. EBV

18.  LACUNAR TYPE Abundant
 COLLAGEN BAND  NODULAR
 POLYMORPHOUS
BACKGROUND
 DXTIC RS CELLS LESS
FREQUENT

20. LACUNAR RS

22.  20-25 %
 MALES > FEMALES
 STRONGLY ASSOC. W/ EBV
 OLDER & YOUNG ADULTS ( BIPHASIC )
 > 50% PRESENT AS STAGE 3-4
accompanied by SYSTEMIC
SYMPTOMS
Prognosis Very Good

23. FREQUENTLY SEE
MONONUCLEAR &
DXTIC RS CELLS
DXTIC RS CELLS
Are numerousMONONUCLEAR

25.  UNCOMMON
 M>F
 OLDER ADULTS
 FREQUENT MONONUCLEAR AND DXTIC
R-S CELLS
◦ REACTIVE T LYMPHOS PREDOMINATES
 40% EBV ASSOC.
 PROGNOSIS EXCELLENT

27.  5% OF CASES , UNCOMMON
 MALES > FEMALES ( < 35 y/o )
◦ Asymptomatic YOUNG MALES WITH
CERVICAL OR AXILLARY
LYMPHADENOPATHY
◦ MEDIASTINAL INVOLVEMENT IS RARE
 NOT ASSOC. W/ EBV
 PROGNOSIS EXCELLENT

28.  NODULAR PATTERN DUE TO
EXPANDED B-CELL FOLLICLES
◦ POPULATED BY L&H CELLS AND REACTIVE
B-CELL
◦ DXTIC RS DIFFICULT TO FIND
 3-5% PROGRESS  DIFFUSE LARGE
CELL

29. POPCORN RS CELLS
L & H variants
NUMEROUS MATURE
LYMPHOCYTES

30.  <5 % LEAST COMMON
 OFTEN ASSOC. EBV
 COMMON
* OLDER PTS.
* HIV
* NON-INDUSTRIALIZED COUNTRIES
 SYSTEMIC SYMPTOMS
 PRESENT AS ADVANCED STAGE
 PROGNOSIS LESS FAVORABLE