Hodgkin Lymphoma Pathology

Question 1

Hodgkin lymphoma is a malignant neoplasm → proliferation of _____

Answer 1

eosinophils, fibrosis

(lymph nodes → spreads to BM, spleen, liver)

Question 2

HL is the MC _______ Lymphoma

Answer 2

Primary Mediastinal

Question 3

Reed-sternberg cells are diagnostic of Hodgkin’s lymphoma. What are they?

Answer 3

Malignant cell of HL: R-S or S-R variant cells

(use immunophenotypic markers to differentiate)

Question 4

Population of Hodgkin Lymphoma compared to Non-Hodgkins (malignant)

Answer 4

• HL: bimodal
• NHL: older adult (>50)

Question 5

_____ or immunodeficiency are risk factors for HL.

Answer 5

EBV infection (mono)

Question 6

RS cell is a B-cell w/more than one _____

Answer 6

nucleus w/eosinophilic nucleoli

(owl eyes; they can be found in other disorders also)

Question 7

Reed-sternberg cells with CD30+, CD15+, Pax5 +, is diagnostic of _____

Answer 7

HL

(CD45(-), Fascin +)

Question 8

HL typically starts in the _______.

Answer 8

peripheral lymph nodes

Question 9

Slow enlargement of lymph nodes in the neck of supraclavicular area, _____ fevers (waxes and wanes), _____ are symptoms of HL.

Answer 9

• Pel-ebstein
• drenching night sweats

Question 10

In addition to B-symptoms, unique sx of HL include _______.

Answer 10

• pruritus
• adenodynia d/t alcohol ingestion

(also hepatosplenomegaly)

Question 11

Why does HL present with a normocytic-normochromic anemia?

Answer 11

• metastasis to BM → pancytopenia
• cytokines disrupt BM

(elevated cytokines can also have a paracrine effect → hypercalcemia)

Question 12

Dx tests for HL

Answer 12

1. CT scan
2. lymph node bx
3. BM bx

Question 13

_____(2 tests) are necessary for staging hodgkin’s

Answer 13

1. CT scan w/contrast
2. 3D PET-CT hybrid using positron-emitting F-18 fluorodeoxyglucose (FDG)

(glycolysis increases due to Warburg effect)

Question 14

Warburg effect

Answer 14

“degenerate cellular energetics”: shift in cellular metabolism to glycolysis → lactate generation. This feeds the malignant cells more carbon to build themselves

(regardless of O2 available)

Question 15

Ann Arbor System for staging HL

Answer 15

1. single node or adjacent group of nodes
2. multiple nodes (same side of diaphragm; Stage 2 Bulky if bulk >10cm)
3. both sides of diaphragm
4. extranodal sites (A: absence of B sx; B: presence of B sx)

Question 16

After staging is complete, you can _____

Answer 16

stratify risk and give your patient a prognosis

Question 17

HL has an increase in ______type symptoms (3)

Answer 17

1. neurologic (ataxia, memory loss, neuropathy)
2. dermopathies (Erythema nodosum, ichthyosis)
3. nephrotic syndrome

Question 18

cure rate for HL

Answer 18

80% at 5 years w/aggressive therapy

(one of the most treatable cancers)

Question 19

Secondary Malignancy is a possible risk of the aggressive chemotherapy that is required to cure HL. Which malignancies are they?

Answer 19

1. NHL
2. Sarcoma
3. AML
4. Carcinoma

(there are permanent changes to the genetics)

Question 20

Which 3 HL subtypes do NOT include EBV as a risk factor?

Answer 20

1. Nodular
2. Lymphocyte-rich
3. Lymphocyte-predominant

Question 21

All of the HL subtypes are CD15+, CD30+, except for _______.

Answer 21

lymphocyte predominance (CD20+, CD15+)

Question 22

Which 2 subtypes of HL present w/T-cell, eosinophil, MF, and plasma cell infiltrates background and RS cells (2)?

Answer 22

1. Nodular
2. Mixed cellularity

Question 23

MC neoplasm of the anterior mediastinum

Answer 23

thymoma

(50% manifest sx of Myasthenia Gravis)

Question 24

lobular nodules of nodular sclerosis HL are from _____

Answer 24

dense collagen bands surrounding malignant cells

Question 25

Which HL subtype has mediastinum involvement, B-sx and is more common in women?

Answer 25

Nodular sclerosing

Question 26

What is the 1st and 2nd MC HL subtype?

Answer 26

1. Nodular Sclerosing 2. Mixed cellularity

Question 27

Which HL subtype is commonly associated w/HIV, has B-sx and a broad age group affected?

Answer 27

Mixed cellularity

Question 28

Which HL subtype has peripheral lymphadenopathy, B-sx, and mononuclear infiltrates?

Answer 28

Lymphocyte-rich

Question 29

Which HL subtype has a poor prognosis, involves the abdominal lymph nodes and has NO mediastinal involvement?

Answer 29

Lymphocyte-depleted

Question 30

Which HL subtype has PAX5+, BCL6+, and “popcorn cells”?

Answer 30

Nodular Lymphocyte Predominance (popcorn cells have nuclei folds that resemble popcorn)

Question 31

Which HL Subtype has a follicular dendritic cell background + RS cells?

Answer 31

Nodular Lymphocyte Predominance (good prognosis, cuz popcorn is delicious)