Hodgkin's lymphoma pathophysiology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sowminya Arikapudi, M.B,B.S. [2]

Pathophysiology

Reed-Sternberg Hodgkin's Lymphoma

Gross Pathology

Affected lymph nodes (most often, laterocervical lymph nodes) are enlarged, but their shape is preserved because the capsule is not invaded. Usually, the cut surface is white-grey and uniform; in some histological subtypes (e.g. nodular sclerosis) may appear a nodular aspect

Microscopic Pathology

Microscopic examination of the lymph node biopsy reveals complete or partial effacement of the lymph node architecture by scattered large malignant cells known as Reed-Sternberg cells (typical and variants) admixed within a reactive cell infiltrate composed of variable proportions of lymphocytes, histiocytes, eosinophils, and plasma cells. The Reed-Sternberg cells are identified as large often bi-nucleated cells with prominent nucleoli and an unusual CD45-, CD30+, CD15+/- immunophenotype. In approximately 50% of cases, the Reed-Sternberg cells are infected by the Epstein-Barr virus.

Reed-Sternberg cells (RSC) (Classical and variants)

Type of cell	Characteristics
Classic
Reed-Sternberg cells (RSC)	Include large size (20–50 micrometres), abundant, amphophilic, finely granular/homogeneous cytoplasm; two mirror-image nuclei (owl eyes) each with an eosinophilic nucleolus and a thick nuclear membrane (chromatin is distributed close to the nuclear membrane).
Variants
Hodgkin cell	(Atypical mononuclear Reed-Sternberg cell) has the same characteristics as Reed-Sternberg cells (RSC), but is mononucleated.
Lacunar Reed-Sternberg cells	Are large, with a single hyperlobulated nucleus, multiple, small nucleoli and eosinophilic cytoplasm which is retracted around the nucleus, creating an empty space ("lacunae").
Pleomorphic Reed-Sternberg cells	Has multiple irregular nuclei.
"Popcorn" Reed-Sternberg cells	(Lympho-histiocytic variant) is a small cell, with a very lobulated nucleus, small nucleoli.
"Mummy" Reed-Sternberg cells	Has a compact nucleus with no nucleolus and basophilic cytoplasm.

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