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Hodgkin's disease, in the World Health Organization (WHO) classification known as Hodgkin lymphoma, is a histologically defined disorder. The term encompasses two distinct types of disease, which differ in aetiology, epidemiology, clinical features, pathology and prognosis [1, 2]. They are designated classical Hodgkin's disease (classical HD) and nodular lymphocyte-predominant Hodgkin's disease (NLPHD). It is now known that both types of Hodgkin's disease are B-cell neoplasms but, because of the fairly distinctive features of this condition, subdivision of lymphoma into Hodgkin's disease and non-Hodgkin's lymphoma (NHL) has been maintained. The cell of origin in both cases is a germinal centre B cell. The differences between these two types of Hodgkin's disease are summarized in Table 24.1. Histologically Hodgkin's disease is defined by the presence of characteristic neoplastic cells (Reed-Sternberg cells and Hodgkin's cells or their variants) in a setting of inflammatory cells with or without fibrosis. Classical HD is further subdivided into lymphocyte-rich, mixed cellularity, nodular sclerosis (or nodular sclerosing) and lymphocyte-depleted subtypes on the basis of the ratio between neoplastic cells and reactive cells, the specific cytological features of the neoplastic cells and the presence or absence of fibrous bands.

Table 24.1A comparison of features of classical and nodular lymphocyte-predominant Hodgkin's disease (HD)

Hodgkin's disease commences in a single lymphocyte in a lymph node or other organ and, in the usual case in which disease starts in a lymph node, spreads initially by lymphatics to contiguous lymph nodes. There may also be local invasion and, late in the course of the disease, spreading through the blood stream to distant ...

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