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Chapter 105. Malignancies of Lymphoid Cells (Part 23)

The diagnosis of Hodgkin's disease is established by review of an adequate biopsy specimen by an expert hematopathologist. In the United States, most patients have nodular sclerosing Hodgkin's disease, with a minority of patients having mixed-cellularity Hodgkin's disease. Lymphocyte-predominant and lymphocyte-depleted Hodgkin's disease are rare. Mixed-cellularity Hodgkin's disease or lymphocyte-depletion Hodgkin's disease are seen more frequently in patients infected by HIV (Fig. 105-11). The differential diagnosis of a lymph node biopsy suspicious for Hodgkin's disease includes inflammatory processes, mononucleosis, non-Hodgkin's lymphoma, phenytoin-induced adenopathy, and nonlymphomatous malignancies. Figure 105-11 Mixed cellularity Hodgkin's disease. A Reed-Sternberg cell is present near the center of. | Chapter 105. Malignancies of Lymphoid Cells Part 23 The diagnosis of Hodgkin s disease is established by review of an adequate biopsy specimen by an expert hematopathologist. In the United States most patients have nodular sclerosing Hodgkin s disease with a minority of patients having mixed-cellularity Hodgkin s disease. Lymphocyte-predominant and lymphocyte-depleted Hodgkin s disease are rare. Mixed-cellularity Hodgkin s disease or lymphocyte-depletion Hodgkin s disease are seen more frequently in patients infected by HIV Fig. 105-11 . The differential diagnosis of a lymph node biopsy suspicious for Hodgkin s disease includes inflammatory processes mononucleosis non-Hodgkin s lymphoma phenytoin-induced adenopathy and nonlymphomatous malignancies. Figure 105-11 Saurea Fivti ns Katpt DL. BhaunvaM f 51. Lange DL.- Jimaïen JL Loictlro Ji F i wrwï j ai Jnttrmï Xé om. 1.7th Edition i hrttp wv i.eocesinn d-cin . cpm CspvHflht El The Cempanlat. Inf Ail rtghtj Ï3i Ï4ÏiïU3i32S Mixed cellularity Hodgkin s disease. A Reed-Sternberg cell is present near the center of the field a large cell with a bilobed nucleus and prominent nucleoli giving an owl s eyes appearance. The majority of the cells are normal lymphocytes neutrophils and eosinophils that form a pleiomorphic cellular infiltrate. The staging evaluation for a patient with Hodgkin s disease would typically include a careful history and physical examination complete blood count erythrocyte sedimentation rate serum chemistry studies including LDH chest radiograph CT scan of the chest abdomen and pelvis and bone marrow biopsy. Many patients would also have a PET scan or a gallium scan. Although rarely utilized a bipedal lymphangiogram can be helpful. PET and gallium scans are most useful to document remission. Staging laparotomies were once popular for most patients with Hodgkin s disease but are now done rarely because of an increased reliance on systemic rather than local therapy. Classical Hodgkin s Disease Treatment .