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  • Hodgkin lymphoma (HL) is a lymphoid neoplasm consisting of two distinct entities: classic Hodgkin lymphoma (cHL), accounting for 95% of cases, and nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL), accounting for about 5% of cases.

  • Both types of HL are derived from germinal center B cells.

  • cHL is defined by the presence of the Reed-Sternberg (RS) cells or its mononuclear variant Hodgkin cells with a characteristic immunophenotype and appropriate cellular background (Figures 60–1 and 60–2).

  • The neoplastic cells account for only 1% to 5% of cells in an affected node or tissue.

  • HL cells secrete cytokines and chemokines, which attract multiple reactive cell types, with T cells predominating. The survival of HL cells is dependent on these cells in the microenvironment.

  • cHL consists of four histologic subtypes that are distinguished based on microscopic appearance and relative proportions of RS cells, lymphocytes, and fibrosis:

    — Nodular sclerosis (~60%–65% of cases) predominates in young adults. The RS cells appear as lacunar cells.

    — Mixed cellularity (~25%–35% of cases) predominates in older adults.

    — Lymphocyte-rich (~5% of cases) is most frequent in males.

    — Lymphocyte-depleted is very rare.

  • The malignant cells in NLPHL are called lymphocytic/histiocytic cells or “popcorn” cells and are embedded in B-cell–rich nodules.

  • The distinguishing pathologic features between cHL and NLPHL are shown in Table 60–1.


High magnification of lymph node section in a patient with Hodgkin lymphoma. A Reed-Sternberg cell is in the center of the field with the classical findings of giant size compared to background lymphocytes, binucleation, and prominent eosinophilic nucleoli.


Classic Hodgkin lymphoma stained with antibody to CD30. CD30 stains the Reed-Sternberg cells in this lymph node biopsy.



  • The incidence of HL is 2 to 3/100,000 per annum in the United States and western Europe.

  • The rate has been stable for several decades.

  • In 2017 in the United States, there were 8260 cases of HL.

  • An increased risk of cHL has been reported in young adults with high socioeconomic status, and the influence of environmental factors is controversial.

  • There is a bimodal age distribution, with a ...

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