Hodgkin Lymphoma

Hodgkin lymphoma (HL), formerly called Hodgkin disease (HD) may respond well to therapy. Thus, it is important to determine the stage of the disease and the histologic type of HD in order to provide the most appropriate therapy. The first four types listed in the table below are "classical HL" and have Reed-Sternberg cells that immunohistochemically are positive for CD15 and CD30 but negative for CD45.

Nodular lymphocyte-predominant HL has RS cells that are CD20 positive but CD15 and CD30 negative, like B cells.

Hodgkin Lymphoma - Classification
TypeHistologic FeaturesFrequencyPrognosis
Nodular sclerosisBands of fibrosis, lacunar cellsMost frequent type (60-80%), more common in womenGood, most are stage I or II
Mixed cellularityComposed of many different cellsMost frequent in older persons, second most frequent overall (15-30%)Fair, most are stage III
Lymphocyte richMostly reactive lymphocytes and many Reed-Sternberg cellsUncommon (5%). Older adultsGood to excellent
Lymphocyte depletionMany Reed-Sternberg cells and variantsRare (<1%)Poor, most are stage III or IV
Nodular lymphocyte-predominantMostly B-cells and few Reed-Sternberg variant cellsUncommon (5%)Good, most are stage I or II

Hodgkin Lymphoma - Staging
IOnly a single lymph node site or extranodal site is involved
IITwo or more lymph node sites on one side of the diaphragm are involved, or limited contiguous extranodal site involvement
IIILymph node sites on both sides of the diaphragm are involved, with splenic or limited contiguous extradodal site involvement, or both
IVExtensive involvement of extranodal sites, with or without lymph node involvement