Hodgkin’s lymphoma and NHL


  • Both Hodgkin’s and NHL – Present as nodal/ extra nodal lesions.
  • Frequently in HIV positive patients
  • Arises in single node/ chain of nodes – spreads to contiguous lymphoid tissues

Hodgkin’s lymphoma:

  • Malignant lymphoma with presence of Reed Sternberg cells
  • Reed Sternberg cells arise from B lymphocyte lineage – have mutations that render it incapable of producing complete immunoglobulin chains
  • 50% of HL are associated with Epstein-Barr virus

Predisposing factors NHL:

  • HIV
  • EBV
  • H. pylori
  • Gluten enteropathy
Clinical presentation of Hodgkin's lymphoma


  • Bone marrow biopsy, PET scan, CT scan, Chest xray

Jamshidi needle – bone marrow biopsy in iliac crest

  • Normochromic normocytic anaemia
  • Leucocytosis
  • Eosinophilia
  • Raised ESR and C-reactive protein
  • Bone marrow involvement in late disease
  • Serum lactate dehydrogenase is raised


  • Reed Sternberg cells: binucleate “mirror image” neoplastic giant cells. Not present in NHL

Histological patterns:

  • A) Classical type:
    • Nodular sclerosis
    • Mixed cellularity
    • Lymphocytic predominance
    • Lymphocyte depletion
  • B) Lymphocyte predominance

Ann Arbor classification for Hodgkin’s and NHL

Class I
– 1 node
– 1 extra lymphatic site/organ
Class II
– 2+ nodes on same side of diaphragm
– Contiguous extra lymphatic organ/tissue
Class III
– Nodes on both sides of the diaphragm
– Contiguous extra lymphatic organ/tissue
– Extra lymphatic site
– Spleen involvement
Class IV
– Multiple foci
– 1+ extra lymphatic organ
Ann Arbor Classification


Diffuse large B-cell lymphoma

  • Most common form of NHL


  • Rapid enlarging mass nodal or extranodal
  • Includes Waldeyer’s ring and oropharyngeal lymphoid tissues – tonsils and adenoids
  • Liver and spleen can also be affected
  • Extra nodal: GIT, Skin, Bone, Brain
  • Aggressive but curable


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