Nodular sclerosis classical hodgkin lymphoma hodgkins. The hodgkin lymphoma infiltrate contains only few of these neoplastic cells approx. Hodgkin lymphoma hl is one of the most frequent lymphomas in the western world, with an annual incidence of about 3 cases per 100,000 persons. Immunohistochemistry of hodgkins disease immunohistochemistry of hodgkins disease hall, p. Nodular sclerosis is the most frequently diagnosed subtype of hodgkin s lymphoma and comprises approximately 60% to 70% of cases in western populations. Pathology outlines nodular sclerosis classic hodgkin. Histopathology lymph nodenodular sclerosis hodgkin lymphom. Nodular sclerosing hodgkins disease and large cell lymphoma. May 15, 2003 atypical, eosinophilia, hodgkin s disease, lymphocyte depletion, adverse effects, toxic effect, hodgkin s disease, nodular sclerosis introduction various approaches in the histologic classification of hodgkin disease hd have been developed since 1944 to predict prognosis on a histomorphologic basis. The canadian cancer society is a national, communitybased organization of volunteers whose mission is the eradication of cancer and the enhancement of the quality of life of people living with cancer.
We report a case of hodgkins lymphoma of the breast in a 61 year old postmenopausal female who presented with a 3 month history of left breast. Nodular sclerosing ns hodgkins disease hd with extensive areas of lymphocyte depletion or with numerous anaplastic hodgkins cells, termed grade ii ns, is associated with a poor response to init. Nodular sclerosing hodgkins disease and large cell. Relationship of histopathologic features to survival and relapse in nodular sclerosing hodgkins disease. Diagnosis of hodgkin lymphoma in the modern era wang. Classic hodgkin lymphoma chl is a monoclonal lymphoid neoplasm in most instances derived from b cells composed of mononuclear hodgkin and multinucleated hodgkin reedsternberg hrs cells residing in an infiltrate containing a variable mixture of nonneoplastic small lymphocytes, eosinophils, neutrophils, histiocytes, plasma cells, fibroblasts and collagen fibers who classification of. For people with earlystage nlphl without any b symptoms, involved site radiation therapy isrt is often all thats needed. Grade 2 represents 15% to 25% of nschl cases, and the syncytial variant is. Hodgkin lymphoma, abbreviated hl, is a haematological malignancy. Despite its well known histological and clinical features, hodgkins lymphoma hl has recently been the object of intense research activity, leading to a better understanding of its phenotype, molecular characteristics, histogenesis, and possible mechanisms of lymphomagenesis. Most patients can be cured if the disease is detected in its early stages, but even those with advanced hodgkin lymphoma have a significant chance. How i treat nodular lymphocyte predominant hodgkin. Nodular sclerosis2 classical hodgkins lymphoma, nodular sclerosis. Nodular sclerosis hodgkins lymphoma, particularly those cases presenting with mediastinal disease, also seems related to primary mediastinal bcell lymphoma.
Nodular sclerosis classical hodgkin lymphoma is the most common subtype of hodgkins lymphoma, also formerly called hodgkins disease. Hodgkin lymphoma, nodular sclerosis subtype pathpedia. We report a case of hodgkin s lymphoma of the breast in a 61 year old postmenopausal female who presented with a 3 month history of left breast. In standard texts, hodgkins lymphoma is classified as 2 distinct entities, namely. Nodularsclerosis classical hodgkin lymphoma is the most predominant subtype. Nodular sclerosing ns hodgkin s disease hd with extensive areas of lymphocyte depletion or with numerous anaplastic hodgkin s cells, termed grade ii ns, is associated with a poor response to init. Childhood hodgkin lymphoma is one of the few pediatric malignancies that shares aspects of its biology and natural history with an adult cancer.
The term hodgkins disease, now renamed as hodgkin lymphoma, was first coined by samuel wilks, in recognition of the earlier report by thomas hodgkin from the guys hospital in london hodgkin, 1832. Nodular sclerosis classical hodgkin lymphoma grade 2. During staging workup, intense gallium67 67ga accumulation in a left breast lump raised the suspicion of an extranodal deposit, but biopsy favoured a benign histology. A lymphoma is classified as hodgkin lymphoma if the reedsternberg cell is detected. Hodgkin lymphoma hl constitutes 10% of all lymphoma cases. Nodular sclerosis or nshl is a form of hodgkins lymphoma that is the most common subtype of hl in developed countries. High relapse rate in children with nonadvanced nodular lymphocyte predominant hodgkin s lymphoma nlphl or nodular paragranuloma treated with chemotherapy only. Hodgkin lymphoma hl is a type of lymphoma in which cancer originates from a specific type of white blood cells called lymphocytes. The neoplastic hodgkin lymphoma cells the hodgkin and reedsternberg cells and their variants have a typical morphology. Grade 2 represents 15% to 25% of nschl cases, and the syncytial variant is the most common morphological type seen via histopathology.
Lls funds lifesaving blood cancer research around the world, provides free information and support services, and is the voice for all blood cancer patients seeking access to quality, affordable, coordinated care. Treating nodular lymphocytepredominant hodgkin lymphoma. Although the mixed cellularity and lymphocytedepleted subtypes may be part of a biologic continuum, the nodular sclerosis subtype has a distinct epidemiology, clinical presentation, and histology. Nodular sclerosing ns hodgkins disease hd with extensive areas of lymphocyte depletion or with numerous anaplastic hodgkins cells, termed grade ii ns, is associated with a poor response to initial therapy, an increased relapse rate, and decreased survival when. About 40% of patients suffer from constitutional symptoms bsymptoms. Jun 29, 2017 nodular sclerosis hodgkin lymphoma histopathology slides for the practical part of the final pathology exam in masaryk university. Lymphoma australia hodgkin lymphoma classifying and staging.
Nodular sclerosing ns hodgkin s disease hd with extensive areas of lymphocyte depletion or with numerous anaplastic hodgkin s cells, termed grade ii ns, is associated with a poor response to initial therapy, an increased relapse rate, and decreased survival when compared with other ns variants, termed grade i ns. Nodular lymphocytepredominant hodgkin lymphoma nlphl is a rare type of hodgkin lymphoma hl that tends to grow more slowly than classic hl chl. Hodgkins lymphoma hl has recently been the object of intense research activity, leading to a better understanding of its phenotype, molecular. We describe the histological and immunophenotypical findings in a case of composite nodular sclerosing hd and highgrade, large cell non hodgkin s lymphoma nhl. Home education eatlas histopathology lymph node hodgkin lymphoma, nodular sclerosis subtype hodgkin lymphoma, nodular sclerosis subtype hodgkin lymphoma, nodular sclerosis. For people with earlystage nlphl without any b symptoms, involved site radiation therapy isrt is often all that s needed. Its histologic featuresmimic metastatic carcinoma, thymoma, melanoma, nonhodgkin lymphoma and germcell tumor. It affects females slightly more than males and has a median age of onset at 28 years. Diagnosis of hodgkin lymphoma in the modern era wang 2019. Altogether, there a four main classic types of hl, but nodular sclerosing is the most common in developed countries, accounting for approximately 60% of patients diagnosed with hl. Pathology outlines nodular sclerosis classic hodgkin lymphoma. Clinical impact of grading the nodular sclerosing hodgkins disease under modern therapy of the german hodgkin study group abstract. Nodular sclerosis hodgkin lymphoma histopathology youtube. Despite its well known histological and clinical features, hodgkin s lymphoma hl has recently been the object of intense research activity, leading to a better understanding of its phenotype, molecular characteristics, histogenesis, and possible mechanisms of lymphomagenesis.
When treatment approaches for children were modeled after those used for adults, substantial morbidities resulted from the unacceptably high radiation doses. Composite lymphomas have rarely been reported in hodgkins disease hd, except in the lymphocyte predominance subtype, and immunohistochemical investigations have been performed in only few cases. As hodgkins lymphoma is a bcell neoplasm, there is also a better appreciation today of cases that may be borderline with conventional b. It is composed of large tumor nodules with lacunar reedsternberg cell rs cells surrounded by fibrotic collagen bands. The first symptom is usually enlarged lymph nodes, and the diagnosis is made by a lymph node biopsy. Often there will be nonpainful enlarged lymph nodes in the neck, under the arm, or in the groin. Is the most common subtype and is composed of large tumor nodules showing scattered lacunar classical rs cells set in a background of reactive lymphocytes, eosinophils and plasma cells with varying degrees of collagen fibrosissclerosis. In standard texts, hodgkin s lymphoma is classified as 2 distinct entities, namely. In addition to the general features described for classic hodgkins lymphoma, the nodular sclerosis. Nodular sclerosing hodgkin lymphoma nshl is the most common type and most curable type of hodgkin lymphoma in developed countries and accounts for 60 to 80 percent of these cancers. Symptoms may include fever, night sweats, and weight loss. Cure leukemia, lymphoma, hodgkin s disease and myeloma, and improve the quality of life of patients and their families.
Nodular sclerosis classical hodgkin lymphoma hodgkins disease. Nodular sclerosis classical hodgkin lymphoma definition. Nodular sclerosis hodgkin s lymphoma, particularly those cases presenting with mediastinal disease, also seems related to primary mediastinal bcell lymphoma. We present the case of a young woman with classical nodular sclerosing hodgkins lymphoma clinical stage iib. Nodular sclerosis hodgkin lymphoma histopathology slides for the practical part of the final pathology exam in masaryk university. This lymphoid malignancy involves peripheral lymph nodes and can also affect organs such as liver, lung, and bone marrow. Dietary pattern and risk of hodgkin lymphoma in a populationbased casecontrol study. It is named after thomas hodgkin who first noticed abnormalities in the lymphatic system in 1832.
A peak incidence is observed in the 1535 years age group. The name hodgkins disease, popular for many years, reflected uncertainty regarding the cellular lineage of the hodgkinreed. There is complete consensus on the b cell derivation of the tumour in most cases, and on the relevance of epstein. Nodular sclerosing hodgkins lymphoma with breast involvement. May 11, 2007 histopathology lymph node nodular sclerosis hodgkin lymphoma. Immunohistochemistry of hodgkins disease, histopathology. A genomewide metaanalysis of nodular sclerosing hodgkin lymphoma identifies risk loci at 6p21. High relapse rate in children with nonadvanced nodular lymphocyte predominant hodgkins lymphoma nlphl or nodular paragranuloma treated with chemotherapy only. A posttreatment 67ga scan showed complete remission of the disease with normal tracer uptake in the left breast.
In the last few years, there has been a greater understanding of the spectrum and biology of hodgkin s lymphoma. Hodgkin lymphoma formerly, hodgkin disease is a potentially curable lymphoma with distinct histology, biologic behavior, and clinical characteristics. Cure leukemia, lymphoma, hodgkins disease and myeloma, and improve the quality of life of patients and their families. Nodular sclerosis hodgkins lymphoma nshl is the most common subtype of hl and represents about 60 % of cases.
Dec 11, 2018 nodular sclerosis classical hodgkin lymphoma is the most predominant subtype. Hodgkin lymphoma subtypes leukemia and lymphoma society. Pdf prognostic significance of histopathological grading. In the last few years, there has been a greater understanding of the spectrum and biology of hodgkins lymphoma. Nodular lymphocyte predominant hodgkin lymphoma nlphl is a unique entity representing. Histopathology lymph node nodular sclerosis hodgkin lymphoma. Hodgkins lymphoma is a rare cancer of the lymphatic system that affects groups of lymph nodes, such as those found in the neck, armpits or groin. However, hodgkin lymphoma is further classified into subtypes which describe the disease in more detail such as what the affected lymph nodes look like, what other cells are present and what characteristics the cells have. Hodgkin lymphoma, nodular sclerosis subtype hodgkin lymphoma, nodular sclerosis. Hodgkins lymphoma rarely involves the thyroid gland. Prognosis is also very good in advancedstage disease but the rate of relapse is higher than in earlystage disease.
Management of hodgkin s lymphoma continues to develop. Often used to denote malignant lymphoma, classifications of which are based on predominant cell type and degree of differentiation. The use of uptodate content is governed by the uptodate terms of. There is complete consensus on the b cell derivation of the tumour in most cases, and on the relevance of. Management of hodgkins lymphoma continues to develop.
Lacunar cells hodgkin cells reedsternberg cells cd30. The disease is defined in terms of its microscopic appearance histology see the image below and the expression of cell surface markers immunophenotype. While the mixed cellularity and lymphocyte depleted subtypes may be part of a biologic continuum, the nodular sclerosis subtype has a distinct epidemiology, clinical presentation and histology. If not otherwise specified, hodgkin lymphoma generally refers to classical hodgkin lymphoma chl rather than nodular lymphocytepredominant hodgkin lymphoma nlphl. Outcomes for patients with favourablerisk, earlystage disease are excellent, and serial reductions in intensity of treatment have been made to retain the excellent prognosis while reducing the late effects of treatment. Seom clinical guidelines for the treatment of hodgkins. This blogpost focuses on the histopathology of the nodular sclerosing subtype of hodgkin lymphoma hl. Hodgkins lymphoma is a cancer that originates in white blood cells known as lymphocytes. We report the clinical and pathologic features of five cases of hodgkins lymphoma that presented as. Both male and female genders are affected equally malefemale ratio is 1. In addition to the general features described for classic hodgkin s lymphoma, the nodular sclerosis subtype also contains fibrous bands and lacunar cells. Josephs regional medical center, paterson, nj, usa 3 department of. Composite lymphomas have rarely been reported in hodgkin s disease hd, except in the lymphocyte predominance subtype, and immunohistochemical investigations have been performed in only few cases.
As hodgkin s lymphoma is a bcell neoplasm, there is also a better appreciation today of cases that may be borderline with conventional bcell lymphomas. Subtype of classic hodgkin lymphoma chl characterized by collagen bands that surround at least one nodule and hodgkin reedsternberg hrs cells with lacunar type morphology who classification of tumours of haematopoietic and lymphoid tissues, 4th edition, lyon 2008 70% of classic hodgkin lymphoma in europe and usa. Relationship of histopathologic features to survival and. Histopathology images of hodgkin lymphoma, nodular. In more advanced cases of hodgkins lymphoma, several lymph nodes from the same group may become matted together, as seen in this group of mediastinal lymph nodes. Nodular sclerosis is the most frequently diagnosed subtype of hodgkins lymphoma and comprises approximately 60% to 70% of cases in western populations. A breast fibroadenoma mimicking an extranodal deposit of. Nshl occurs most commonly between the ages of 15 and 35 and. Lymphocyterich classical hodgkin lymphoma an overview. Hodgkin lymphoma, an uncommon cancer of the lymphatic system malignant lymphoma that usually strikes young adults and people 55 years of age or older. Apr 27, 2014 this blogpost focuses on the histopathology of the nodular sclerosing subtype of hodgkin lymphoma hl.
Histopathology lymph nodenodular sclerosis hodgkin. Nodular sclerosis hodgkin lymphoma may also be related to primary mediastinal bcell lymphoma and mediastinal grey zone lymphomas. The familial risk of hodgkins lymphoma ranks among the highest in the swedish familycancer database. We describe the histological and immunophenotypical findings in a case of composite nodular sclerosing hd and highgrade, large cell nonhodgkins lymphoma nhl. Body mass index and risk of non hodgkin s and hodgkin s lymphoma. Nodular sclerosis hodgkin lymphoma is the most classical hodgkin lymphoma and most common hodgkin lymphoma overall. Nodular sclerosis hodgkins lymphoma, particularly those cases presenting with mediastinal disease, also. The correlation of histopathology with other prognostic indicators in hodgkins disease. Josephs regional medical center, paterson, nj, usa 2 department of internal medicine, st. Antigens expressed on reedsternberg cells, the hallmark of hodgkin disease, and otherneoplastic cells were screened to determine the correct diagnosis. The two most often encountered patterns of growth are 1 follicular sometimes referred to as nodular in which the lymphoma mimics follicular center structures and 2 diffuse in which the lymphoid cells proliferate in an apparently unorganized fashion. Based on the characteristics of the hodgkin and reedsternberg hrs tumour cells lacunar cells, multinucleated giant cells, pseudosarcomatous cells and of the reactive infiltrate, four histologic subtypes of classical hodgkin lymphoma chl have been distinguished. Histopathology lymph nodenodal marginal zone bcell.
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