Hodgkin's vs Non-Hodgkin's lymphoma

Lymphoma (malignant lymphoma, ML)

Definition:
   Lymphoma is a group of cancers arising primarily from lymph nodes and/or extranodal lymphoid tissues, showing features of lymphocytes.

Classification 
Hodgkin’s lymphoma (HD)
non-Hodgkin’s lymphoma (NHL)

 Hodgkin’s lymphoma(HL)
 Introduction
1. Age:two peaks of incidence
young adult: 15-27 years of age about 50 years of age

Hodgkin Lymphoma

 LM
 2. Feature → Reed-Sternberg cells (R-S c)   
mixed with rich inflammatory background
(1)  R-S cell

• 15-45 um in diameter
• Binucleate or multiple nuclei, acidophilic nucleoli
• Amphophilic  cytoplasm

R - S cell

 Mirror image cell

 R-S cell 
with symmetric binuclei

 Hodgkin cell single nucleus R-S cell 

Others (variants)
i) Lacunar cell:
folded, multilobate nuclei surrounded
by pale cytoplasm

 ii) Type L & H R-S cell 
(Popcorn cell):
     have twisted , multilobate nuclei    
     resembling  popcorn kernels
iii) Undifferentiated or  Pleomorphic   R-S c

Popcorn cell

(2) Background
 1) Inflammatory c infiltration
Main: lymphocyte
Others:   plasam cells, neutrophil, eosinophil , histocyte
2) Fibrosis

Histological classification
1.Nodular lymphocyte predominant
      Hodgkin’s lymphoma 
2. Classical Hodgkin’s lymphoma

Classical Hodgkin’s lymphoma
   Features:
1-R-S c and Hodgkin c
2-Background: lymphocyte Plasma C, neutrophil, eosinophil, histocyte

(1)Nodular sclerosis HL
(2) Lymphocyte-rich classical HL
(3) Mixed cellularity
(4) Lymphocyte depletion

 Nodular sclerosis HL
Age:Young woman, 
Common Site:
I)cervical LN
II)supraclavicular
III)mediastinal LN
Prognosis: excellent
Features:

• The presence of a particular variant of R-S c lacunar cells
• The collagen bands that divided LN into circumscribed nodules

Nodular sclerosis HL

Nodular sclerosis HL :Lacunar  cell

(2)Lymphocyte-rich classical HL

1. Hodgkin c and mirror image c             
2. Background :LC or histocyte

Lymphocyte-rich classical HL

(3) Mixed cellularity, MC:
  Most common  form of HL

•  Plantiful typical R-S cell
•  Background: LC, PlasmaC, Eosiphil C, histocyte, fibroblast
•  Small areas of necrosis and fibrosis

Mixed   cellularity

CD30+

CD15

CD30

CD3

EBV: LMP-1

EBV: EBER

Fish: EMER

(4) Lymphocyte depletion, LD
i)LC ↓ 
ii)relative abundance 
iii)R-S cell
iv)pleomorphic variants
     
 Two morphologic forms
i) Diffuse fibrosis
-LC ↓
-amorphous  protein materials↑  reticular fiber ↑
-R-S cell, histocyte, LC:less

ii) Reticular variants
 rich in cell:

• Highly anaplastic R-S c
• A few typical R-S cell
• Massive necrosis
• Poorly prognosis

Reticular variants

 Pathological diagnosis
1. Dependent on the LN biopsy
     Diagnostic value      
-Typical R-S cell  ---→ HL
-Lacunar cell ---→ nodular sclerosis

2. Immunohistochemistry
help to diagnosis
BC: CD20 (+) ---→ nodular LC predominance
HL: CD15 , CD30 (+)

           Stage  of  HD

The Non- Hodgkin lymphomas 
   The non- Hodgkin lymphoma are solid tumours arising in the peripheral lymphoid tissue particularly of lymphnodes but also of the extranodal sites such as the oro- pharynx, the gut, skin and other sites.

1. two-third  ---→    primary in LN
   one-third   ---→   primary in    
extranodal organs and tissues such as digestive , respiratory tract,lung , skin , CNS 
2. Diagnosis:dependent on the biopsy of LN or related tissue pathological diagnosis
-Histological classification
-Immune phenotype of tumor c

3. Classification

Model of LC transformation 

Gross: 

• The same as Hodgkin’s diseases but the mass is more soft and a few necrosis.
• The normal architecture of lymph node have been destroyed partly or entirely.
• Very numerous monotonous neoplastic cell flood in lymph node.
• The neoplastic cell may be infiltrate to the capsule of node.

B-cell small lymphocytic 

Example of Non-Hodgkin’s lymphoma 

1. Follicular lymphoma
2. Diffuse large B-cell lymphoma
3. Burkitt lymphoma
4. Mycosis fungoides

 Follicular lymphoma
 Drive from germinal center BC
 The most common form in the US
  (20-45%)
 Less in China(10%) 
 Age:adult 
Pathological features
Nodular growth pattern
Tumor follicle: composed of
i)Centrocyte:irregular and cleaved nuclear, scant cytoplasm
ii)Centroblast:open nuclear chromatin,several nucleoli

 Diffuse large B-cell lymphoma

• Centroblast lymphoma
• B immunoblast lymphoma
• Anaplastic large BC lymphoma
• TC-rich/histocyte BC lymphoma
• Plasmablast lymphoma

Pathological features

• Relatively large cell:4-5 times the diameter  of small LC
• A fair degree of  morphologic variation: centroblast , immunoblast
• Cell morphology: round or oval nucleus,2-3  nucleoli, margination of  chromatin moderate cytoplasm
• Diffuse pattern of growth

Diffuse large cell,centroblastic

Burkitt’s lymphoma

• Brukitt’s lymphoma was described initially in Africa, where it is endemic in some parts, but it is also ocure sporadically in nonendemic area.
• Rare cases have been recorded in European and North America.
• This disorder is relationship of the Epstein-Barr viruses.
• Both the African and non Africa cases are found largely in children or young adults. 

Presentation of disease:
The disease rarely arises in lymph nodes, but usually appears in the jaw or ovaries (retroperitoneal tissues in males) this disease grows extremely rapidly and spreads extensively, leading quickly to complication.

Histological appearance is typical and striking
   1. diffuse proliferation of lymphoblasts (B cell type) cell medium- sized and uniform, mitoses frequent.
   2. Scattering of macrophages containing debris desired from very rapid cell turnover contributing ‘starry sky’. These benign macrophage are diffusely distributed among the tumor cell. The macrophage often sounded by a clear space.
NOTE:   Leukemic transformation may occur, but is uncommon, these tumors respond well to aggressive chemotherapy and long remissions have been reported. However, in most cases a relapse occurs, and a majority of patients die with in 5 years.

Burkitt’s lymphoma,starry-sky

Burkitt’s lymphoma,mitoses

Mycosis fungoides

   Mycosis fungoides are uncommon lymphoid malignancies that are primary in the skin. It is infrequent T cell lymphomas. These disease usually affects males 40-60 years of age.
   Grossly: The lesions begin as poorly defined areas of eczema, followed by formation of plaques and ultimately of multiple nodules. The nodules often rapture and become ulcer.
 Histologically: 
  This disease is characterized by dermal infiltrates of atypical lymphoid cell that invade the epidermis. The neoplastic cell (mycosis cells) have deeply lobulated or cerebra-form nuclei. Immunology studies indicate the presence of T cell markers on mycosis cells.