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Hodgkin's Lymphoma (HL) Subtypes


A patient of Dorothy Reed.
FIVE subtypes are identified, divided into two subgroups.

1) Classic Hodgkin's Lymphoma
So-called "classic" HL includes:


        In this group typical
RS cell
RS cell
Reed-Sternberg cells can be found. They are most numberous in mixed celluarity, may be numerous or sparse in nodular sclerosis, and are often bizarre and sarcomatoid in lymphocyte depletion. The Reed-Sternberg cells and variants usually lack surface molecules characteristic of B or T-cells but instead are immunoreactive for CD15 (aka LeuM-1) and CD30 (aka Ki-1) antibodies.
        The background lymphocytes are mostly T-cells. Untreated these entities progress to subtypes with increasing numbers of Reed-Sternberg cells. When Hodgkin's lymphoma was untreatable, widespread lymphocyte depletion Hodgkin disease with many bizarre Reed-Sternberg cells was often found at autopsy.
        Even within this subgroup,
Lacunar cell
Lacunar cell
nodular sclerosis is a bit of a specialty item. It is the only HL subtype more common in women than men, and it very often presents with a mediastinal mass. Named for the dense fibrous bands that subdivide involved lymph nodes, it has a prognosis slightly better than mixed cellularity HL. In formalin-fixed tissue a morphologically variant Reed-Sternberg cell called the "lacunar cell" is found.
        As the molecular techniques for probing lineage markers in cells become more refined, new discoveries hint that the Reed-Sternberg cells in most cases of the subtypes of classic HL are derived from B-cells, albeit gravely damaged ones (Schwartz RS. Hodgkin's Disease--Time for a Change. N Engl J Med 1997; 337:495-6).

2) Nodular Lymphocyte-Predominance Hodgkin's Lymphoma
Because the tumor cells
L&H cell
of nodular lymphocyte predominance have a B-cell immunophenotype and are negative for CD15 and CD30 (and for other reasons), it has long been suspected of being a kind of B-cell lymphoma. Typical Reed-Sternberg cells are rare to non-existent; instead polylobated variants called L & H cells (colloquially "popcorn cells") are seen. The background lymphocytes are B-cells.
        Sometimes the disease is preceded by follicular hyperplasia . Progressive transformation of germinal centers, which usually is not associated with HL, occasionally may precede, accompany, or post-date it . Addtional distinctive clinical features setting apart nodular lymphocyte predominance HL include:

  • an indolent though relapsing course with an excellent prognosis;
  • occasional cases relapsing as high-grade B-cell non-Hodgkin's lymphoma;
  • a peak incidence in males in their 30's and 40's, without the bimodal age pattern of classic HL;
  • a greater tendency to be restricted to cervical lymph nodes.
Immunophenotype
The immunophenotypes of the Reed-Sternberg cells and variants in the two subgroups of HL are mirror images:

  CD15 CD30 LCA
(all leukocytes)
CD20
(B-cells)
EMA
Classic Hodgkin+ + - - -
Lymphocyte Predominance - - + + +

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