27-year-old female experienced painless swelling of supraclavicular lymph nodes on her left side. A lymph node was excised.
- The architecture of the lymph node is effaced by a mixed cellular infiltrate.
- Within the background of the mixed infiltrate numerous mononuclear Hodgkin and multinucleated Reed-Sternberg cells are distinguished. The latter are diagnostic of classical Hodgkin’s lymphoma.
- Hodgkin cells are large slightly acidophilic to amphophilic cells containing one nucleus outlined by a thick nuclear membrane. A large usually centrally located, highly acidophilic nucleolus surrounded by a clear halo is characteristic. Reed-Sternberg cells are the multinucleated variants of Hodgkin cells and thus display according nuclear features. To be diagnostic, Reed-Sternberg cells must contain minimally two nucleoli in two separate nuclear lobes. If the two nuclei are arranged in a mirror image like fashion, the typical ‘owl eye’ appearance is observed.
- Hodgkin and Reed-Sternberg cells, the actual tumor cells, account for only a minority of the cells of the infiltrate. The background infiltrate is composed of lymphocytes, eosinophilic granulocytes, plasma cells and histiocytes.
- On occasion, non-caseating granulomas may be observed (not seen on the section shown).
Epidemiology: Classical Hodgkin lymphoma accounting for 95% of all Hodgkin lymphomas shows a bimodal age distribution with a first peak incidence at 15-35 years and a second between the 6th and 7th decade. Mixed cellularity classical Hodgkin lymphoma accounts for 20-25% of classical Hodgkin’s lymphoma and does not display a bi-modal age distribution (median age 37 years).
Clinical features: Most frequent presenting symptom of classical Hodgkin lymphoma is peripheral lymphadenopathy affecting 1 to 2 node-bearing areas. Around 40% of patients suffer from systemic symptoms (B symptoms), namely relapsing fever (so-called Pel-Epstein fever), night sweats and significant body weight loss. Patients with mixed cellularity Hodgkin lymphoma often present at an advanced stage (III or IV).
Staging: Clinical and occasionally pathological staging determine the mode of treatment of Hodgkin’s lymphomas. Stage and the presence of B symptoms are important predictive factors regarding prognosis.