Histology

The classical cell seen on histological examination is the Reed-Sternberg cell, which is a necessary, but not a sufficient element, for the diagnosis of Hodgkin's disease. Other cells seen in diseased tissue include histiocytes, lymphocytes, plasma cells, eosinophils and fibroblasts.

Currently histologic classification for adult Hodgkin lymphoma is carried out according to the World Health Organization (WHO) modification of the Revised European-American Lymphoma (REAL) classification (WHO/REAL classification)

• classical Hodgkin's disease – is further divided into four types:
  • lymphocyte predominant:
    • thought to be a clinically distinct B cell lymphoma
    • often only affects a single lymph node
  • nodular sclerosis:
    • accounts for 70-80% of Hodgkin's disease
    • classically a disease of young women
    • presents with cervical and mediastinal lymphadenopathy
  • mixed cellularity:
    • commonly found in elderly people
    • often widespread at presentation
  • lymphocyte depleted:
    • more prevalent in immunocompromised patients
    • more commonly seen in developing countries where it has a strong association with EBV infection (1,2)
• nodular lymphocyte predominant (NLPHL)
  • HRS cells are not present
  • has a risk of transformation to high grade non-Hodgkin lymphoma
  • managed differently from classical HL

Reference:

• (1) Guidelines for the First Line Management of Classical Hodgkin Lymphoma (2014). British Committee for Standards in Haematology (BCSH)
• (2) National Cancer Institute, National Institutes of Health. Adult Hodgkin lymphoma treatment