Clinical:

• 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

Diagnosis

• 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

Histology

• 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 I/IE	– 1 node – 1 extra lymphatic site/organ
Class II II/IIE	– 2+ nodes on same side of diaphragm – Contiguous extra lymphatic organ/tissue
Class III III/IIIS/IIIE/IIIES	– 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

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Diffuse large B-cell lymphoma

• Most common form of NHL

Clinical:

• 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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