Hodgkin's lymphoma classification
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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] Mohsen Basiri M.D.
Overview
Hodgkin's lymphoma (HL) may be classified according to World Health Organization (WHO) into two major subgroups: nodular lymphocyte predominant and classic Hodgkin's lymphoma. classic Hodgkin's lymphoma is further divided into four subtypes: nodular sclerosis classic HL (NSHL), mixed cellularity classic HL (MCHL), lymphocyte rich classic HL (LRHL), and lymphocyte depleted classic HL (LDHL).
Classification
Hodgkin's lymphoma may be classified according to World Health Organization (WHO) into two major subgroups based upon the appearance and immunophenotype of the tumor cells:[1]
- Nodular lymphocyte predominant Hodgkin's lymphoma
- Classical Hodgkin's lymphoma
Classic Hodgkin's lymphoma is further divided into four subtypes:
- Nodular sclerosis classic HL (NSHL)
- Mixed cellularity classic HL (MCHL)
- Lymphocyte rich classic HL (LRHL)
- Lymphocyte depleted classic HL (LDHL)
| Name | Description |
|---|---|
| Nodular sclerosing | Most common subtype and is composed of large tumor nodules showing scattered lacunar classical Reed–Sternberg cells set in a background of reactive lymphocytes, eosinophils, and plasma cells with varying degrees of collagen fibrosis/sclerosis. |
| Mixed-cellularity | Common subtype and is composed of numerous classic Reed-Sternberg cells admixed with numerous inflammatory cells including lymphocytes, histiocytes, eosinophils, and plasma cells without sclerosis. This type is most often associated with Epstein–Barr virus (EBV) infection and may be confused with the early, so-called 'cellular' phase of nodular sclerosing classical Hodgkins lymphoma. |
| Lymphocyte rich | Rare subtype, show many features which may cause diagnostic confusion with nodular lymphocyte predominant B-cell Non-Hodgkin's Lymphoma (B-NHL). This form also has the most favorable prognosis. |
| Lymphocyte depleted | Rare subtype, composed of large numbers of often pleomorphic Reed-Sternberg cells with only few reactive lymphocytes, which may easily be confused with diffuse large cell lymphoma. Many cases previously classified within this category would now be reclassified under anaplastic large cell lymphoma. |
- According to the Ann Arbor Staging System with Cotswolds modifications[2], there are 4 stages of Hodgkin's Lymphoma based on clinical features gathered from history and physical examination, and findings on positron emission tomography/computed tomography (PET/CT) scan of the chest, abdomen, and pelvis. Each stage is assigned one letter and one number that designate the number of involved lymph node regions and the presence/absence of symptoms or of bulky or extended disease . The stages of Hodgkin's Lymphoma are shown in the table below:
| Hodgkin's Lymphoma | |
| Stage | Definition |
| I | Involvement of a single lymph node (I) or single extranodal site (IE) |
| II | Involvement of two or more lymph node ereas on the same side of the diaphragm alone (II) or with involvement extralymphatic organ (IIE) |
| III | Involvement of lymph node ereas or lymphoid structures on both sides of the diaphragm |
| IV | Disseminated or multiple involvement of the extranodal organs |
In the Ann Arbor Staging System with Cotswolds modifications letters A and B indicate the absence (A) or presence (B) of one or more of these systemic symptoms: fevers with temperatures above 38°C (>100.4°F) during the previous month, drenching night sweats, and/or unexplained weight loss exceeding 10 percent of body weight during the six months prior to diagnosis.
References
- ↑ Swerdlow, S. H.; Campo, E.; Pileri, S. A.; Harris, N. L.; Stein, H.; Siebert, R.; Advani, R.; Ghielmini, M.; Salles, G. A.; Zelenetz, A. D.; Jaffe, E. S. (2016). "The 2016 revision of the World Health Organization classification of lymphoid neoplasms". Blood. 127 (20): 2375–2390. doi:10.1182/blood-2016-01-643569. ISSN 0006-4971.
- ↑ Lister TA, Crowther D, Sutcliffe SB, Glatstein E, Canellos GP, Young RC; et al. (1989). "Report of a committee convened to discuss the evaluation and staging of patients with Hodgkin's disease: Cotswolds meeting". J Clin Oncol. 7 (11): 1630–6. PMID 2809679.