Histologic Subtypes
Hodgkin Lymphoma (HL) is divided into 2 main categories defined by the REAL (Revised European American Lymphoma) Update of the WHO classification:
- Classical HL
- Nodular Lymphocyte Predominant Hodgkin Lymphoma (NLPHL)
Classical Hodgkin Lymphoma
Classical Hodgkin Lymphoma is further divided into 4 histologic subtypes according to:
- Number and morphology of Reed-Sternberg cells
- Composition of cellular background in the biopsied material.
The 4 subtypes of Classical Hodgkin Lymphoma are:
- Nodular sclerosis
- Mixed cellularity
- Lymphocyte depleted
- Lymphocyte rich.
Pathological summary of classical Hodgkin lymphoma subtypes:
Nodular Sclerosis |
Mixed Cellularity |
Lymphocyte Depleted |
Lymphocyte Rich |
|
Proportion of children |
40-50% |
30-35% |
<5% |
<1% |
Proportion of adolescents |
70-80% |
10-15% |
||
Type of R-S |
Lacunar |
Classical (most) Mononuclear (few) Lacunar (few) |
Classical Bizarre sarcomatous |
Classical |
Quantity of R-S |
Varies |
Varies |
Abundant |
Few |
Infiltrate Composition |
Lymphocytes Histiocytes Plasma cells Eosinophils Neutrophils |
Lymphocytes Epitheloid histiocytes Eosinophils Plasma cells |
Limited inflammatory cells |
Lymphocytes Histiocytes |
Cellular pattern |
Partially nodular |
Diffuse and vaguely nodular |
Diffuse and hypocellular |
Diffuse or nodular |
Morphological Features |
Capsular/intranodal fibrosis
Fibrous bands divide lymph nodes into nodules
Areas of necrosis |
No band-forming sclerosis
Reactive follicular hyperplasia |
Paucity of lymphocytes
Diffuse fibrosis
Necrosis |
Diffuse: predominance of small T lymphocyte and no germinal centre involvement
Nodular: resembles follicular |
Other |
Mediastinum (above the diaphragm) |
Common sites: abdominal lymph nodes and spleen Confused with peripheral T-cell lymphoma |
Frequently misdiagnosed with non-Hodgkin’s anaplastic large cell type |
Sometimes difficult to distinguish from nodular lymphocyte predominant HD |
| Prognosis | Better prognosis | Intermediate amongst the classical subtypes | Worst amongst the classical subtypes | Better prognosis |
Nodular Lymphocyte Predominant Hodgkin Lymphoma (NLPHL)
