Hodgkin lymphoma
How rare Hodgkin Reed–Sternberg cells, crippled B cells that escaped death, build a tumour made mostly of reactive cells, why their cytokines cause fever, sweats and weight loss, and how the disease spreads node by node.
By the end, you can
- Explain how Hodgkin Reed–Sternberg cells arise from germinal centre B cells and how they are recognised (morphology, CD30 and CD15).
- Relate the cytokines and chemokines of HRS cells to the reactive background, fibrosis, B symptoms and impaired immunity.
- Compare the subtypes of classic Hodgkin lymphoma with the nodular lymphocyte-predominant form, and state the EBV associations accurately.
- Explain contiguous nodal spread and what Lugano (Ann Arbor) staging measures.
- Recognise the classic appearances, staging, risk groups and tests of Hodgkin lymphoma, and explain how chemotherapy, radiotherapy, brentuximab vedotin and PD-1 checkpoint inhibitors act on the HRS cell.
What it is
Hodgkin lymphoma is a B-cell lymphoma in which a small number of large malignant cells sit in a much larger background of reactive inflammatory cells. Classic Hodgkin lymphoma (about 90–95 per cent), with Hodgkin and Reed–Sternberg (HRS) cells, has four subtypes; the uncommon nodular lymphocyte-predominant Hodgkin lymphoma (WHO 5th edition name; renamed nodular lymphocyte-predominant B-cell lymphoma by the International Consensus Classification, ICC) has LP cells that keep their B-cell features.
4 types to tell apart
- Nodular sclerosis
- The commonest classic subtype in high-income countries: young adults, mediastinal mass, collagen bands and lacunar cells.
- Mixed cellularity
- More HRS cells in a mixed background; older adults and people with HIV; usually EBV-positive.
- Lymphocyte-rich and lymphocyte-depleted
- Classic HRS cells among many small lymphocytes, or many HRS cells with few lymphocytes (rare).
- Nodular lymphocyte-predominant
- NLPHL (WHO 5th) or NLPBL (ICC): CD20-positive LP cells in B-cell nodules; EBV-negative; slow-growing.
US spelling: centre → center, tumour → tumor.
Normal function
Germinal centre selection and chains of nodes
In a , B cells mutate their antibody genes and survive only if their new B-cell receptor still works and binds antigen. The rest, including cells whose mutations have wrecked the receptor, die by apoptosis within hours. This strict selection is the safeguard that Hodgkin lymphoma escapes.
A node is also a community. T cells in the , macrophages, eosinophils, plasma cells and fibroblasts are recruited and directed by cytokines (signalling proteins) and chemokines (signals that attract cells). In infection, cytokines such as interleukin-6 (IL-6) and tumour necrosis factor (TNF) also act on the whole body, causing fever and loss of appetite.
Nodes are linked in chains: lymph leaves each node through its to the next, from the neck to the nodes above the collarbone and on to the mediastinum, and from the abdomen up the para-aortic nodes to the thoracic duct.
Underlying change · Step 1 of 4
The Hodgkin Reed–Sternberg cell
The full lesson is part of Student Pro
It takes you through all 4 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Disrupted function · Step 2 of 4
A tumour made mostly of reactive cells
The full lesson is part of Student Pro
It takes you through all 4 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Underlying change · Step 3 of 4
Classic subtypes, EBV and the lymphocyte-predominant form
The full lesson is part of Student Pro
It takes you through all 4 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Consequences · Step 4 of 4
Contiguous spread, symptoms and staging
The full lesson is part of Student Pro
It takes you through all 4 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Symptoms and signs
Symptoms, signs and findings
The full lesson is part of Student Pro
It takes you through all 4 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Exam detail
Exam detail
The full lesson is part of Student Pro
It takes you through all 4 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Treatment
How treatment works
The full lesson is part of Student Pro
It takes you through all 4 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Recap
Recap
The full lesson is part of Student Pro
It takes you through all 4 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Self-check
Check your understanding
The full lesson is part of Student Pro
It takes you through all 4 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .