Pathology of Hodgkin Lymphoma

Part of the Molecular Pathology Library book series (MPLB)


The primary objective of this chapter is to describe the histopathologic features of Hodgkin lymphoma and its many variants. Hodgkin lymphoma is a lymph node-based neoplasm derived in nearly all cases from clonal genetically unstable germinal center B lymphocytes. There are two highly distinct types of Hodgkin lymphoma that differ in clinical features, pathobiology, and histopathology. The clonal cells in the more common classical form of Hodgkin lymphoma termed classical Reed-Sternberg cells are large cells with multinucleated or multilobulated nuclei, prominent nucleoli, and a unique immunophenotype that belies their B cell origin. The histopathologic diagnosis of classical Hodgkin lymphoma relies on morphologic and immunohistochemical detection of classical Reed-Sternberg cells within a reactive inflammatory infiltrate composed of variable numbers of small lymphocytes, granulocytes, and macrophages, with variable degrees of fibrosis. In contrast, while the clonal cells of nodular lymphocyte predominant Hodgkin lymphoma, termed LP cells, are also B cell derived, their morphologic and immunophenotypic features differ markedly from that of classical Reed-Sternberg cells. LP cells are typically medium-sized mononuclear cells with irregular lobulated nuclei that, in contrast to classical Reed-Sternberg cells, express a B cell immunophenotype. Also, in contrast to classical Hodgkin lymphoma, the reactive infiltrate in most cases of nodular lymphocyte predominant Hodgkin lymphoma consists of mantle zone B cells and CD4 T cells without granulocytes and fibrosis. The histopathology of entities that are related to or may mimic Hodgkin lymphoma, including Castleman disease, progressive transformation of germinal centers, and mediastinal gray zone lymphoma, is briefly discussed.


Classical Hodgkin lymphoma Nodular sclerosis HL Mixed cellularity HL Lymphocyte-depleted HL Lymphocyte-rich HL Reed-Sternberg cell Nodular lymphocyte predominant HL LP cell Histopathology Immunohistochemistry Epstein-Barr virus T cell/histiocyte-rich large B cell lymphoma Castleman disease Progressive transformation of germinal centers Anaplastic large cell lymphoma Hallmark cell Mummified cell 



Anaplastic large cell lymphoma


Classical Hodgkin lymphoma


Classical RS cell


Epstein-Barr early RNA


Epstein-Barr virus


Hodgkin lymphoma


Insulin-like growth factor




In situ hybridization


Lymphocyte-depleted Hodgkin lymphoma


Latent membrane protein


Lymphocyte predominant


Lymphocyte-rich Hodgkin lymphoma


Mixed cellularity Hodgkin lymphoma


Non-Hodgkin lymphoma


Nodular lymphocyte predominant Hodgkin lymphoma


Nodular sclerosis Hodgkin lymphoma


Progressive transformation of germinal centers




Reed-Sternberg cell


T cell/histiocyte-rich large B cell lymphoma


Follicular T helper cell


Tumor-derived growth factor beta


Regulatory (suppressor) T cells


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© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Pathology and Laboratory MedicineYale University School of MedicineNew HavenUSA

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