1. HODGKIN LYMPHOMA

2. Classifications 1%

3. Hodgkin lymphoma 1% of all cancers Arises in lymph nodes –(tons., Wald., EXN rare) Spreads predictably characteristically to the anatomically contiguous nodes LN – spleen – liver – BM Staging: prognosis, choice of therapy

4. Patients Average: 32 years; slight male predominance (NS: M=F) Curable in many cases Lon-term survivors of chemo- and radiotherapy: Risk of developing second cancers MDS, AML, lung cancer, breast cancer

5. HODGKIN LYMPHOMA WHO 2008  CLASSICAL (95%)  NODULAR LYMPHOCYTE PREDOMINANT (nodular paragranuloma, 5%) DIFFER IN: TUMOUR CELLS BACKGROUND CLINICAL FEATURES

6. CLASSICAL HL FEATURES  COMMON TUMOUR CELLS  DIFFERENT BACKGROUND ARCHITECTURE CLINICAL, EPIDEMIOLOGY EBV SUBTYPES NODULAR SCLEROSIS MIXED CELLULARITY LYMPHOCYTE RICH LYMPHOCYTE DEPLETION

7. TUMOUR CELLS OF CLASSICAL HL Diagnostic only RS! Hodgkin cell eggs in the basket CD30+,CD15+ B-markers, EBV mummy lacunar

8. Classical HL NODULAR SCLEROSIS 70% CHL; 28 ys; M=F stage II, mediastinum 40% B-symptoms MIXED CELLULARITY grade I and II 20% CHL; 37 ys; 70% M stage III-IV peripheral lymph nodes spleen, bone marrow B-sympt., EBV common HIV

9. LYMPHOCYTE RICH LYMPHOCYTE DEPLETION Classical HL 5% CHL; older; 70% M stage I-II peripheral lymph nodes B-sympt. rare, but relapses <5% CHL; 37ys; 75% M advanced B-symptoms common poor, HIV (EBV)

10. Nodular lymphocyte predominance HL Nodular/diffuse pattern L&H; LP = popcorn cells Background FDC meshworks nonneoplastic lymphocytes Very favourable prognosis CD20

11. Reed-Sternberg cell: communication with other cell types

12. Hodgkin lymphoma – Ann Arbor staging I, II above diaphragm below III, IV Pruritus, anorexia; B sympt. correlate with stage