Hodgkin’s lymphoma

Published on 03/04/2015 by admin

Filed under Hematology, Oncology and Palliative Medicine

Last modified 03/04/2015

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Hodgkin’s lymphoma

The lymphomas are malignant disorders of lymphoid tissue subdivided into two broad groups – Hodgkin’s lymphoma (HL) and non-Hodgkin’s lymphoma (NHL).

Hodgkin’s disease was first described by Thomas Hodgkin in 1832. In developed countries there is a bimodal age distribution with peak incidences in young adults (15–35 years) and the more elderly (over 50 years). The disease is commoner in men.

Aetiology

Hodgkin’s lymphoma is an unusual malignancy in that the malignant cells, termed Reed–Sternberg cells (Fig 29.1), and mononuclear Hodgkin’s cells form only a minority of the tumour. The remainder is composed of very variable numbers of other cells including lymphocytes, granulocytes, fibroblasts and plasma cells. This inflammatory cell infiltrate presumably reflects an immune response by the host against the malignant cells. Reed–Sternberg (RS) cells appear to originate from germinal-centre B-lymphocytes. In classical HL the RS cells are ‘crippled’ germinal-centre B-cells incapable of secreting immunoglobulins, while in lymphocyte predominant nodular HL RS cells the coding regions of the immunoglobulin genes are intact and potentially functional.

Epstein–Barr virus (EBV) may play a role in classical Hodgkin’s lymphoma, particularly the mixed cellularity subtype. When the disease occurs in patients with HIV infection and after solid organ transplantation it is often EBV-associated. There is no specific chromosomal translocation associated with Hodgkin’s lymphoma.

Clinical presentation

Lymphocyte predominant nodular Hodgkin’s lymphoma

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