19. Hodgkin lymphoma

Overview

Staining: HE

Organ: Lymph node

Description:

The basic structure of the lymph node is lost. Darker, basophilic regions are separated by brighter zones made up of fibrosis.

Compared to the slides of most other lymphoid neoplasms are very few of the cells in these basophilic regions tumor cells. The tumor cells are surrounded by a background of reactive inflammatory cells –healthy cells that react to the tumor cells.

The pathognomic Reed-Sternberg cell

The characteristic cell type for Hodgkin lymphoma is the Reed-Sternberg cell. These large cells have large nuclei and prominent nucleoli and are tumor cells. They most frequently contain two or three nuclei. They may be mononuclear, in which case they’re called simply Hodgkin cells. Binuclear Reed-Sternberg cells appear to have a mirror axis, giving them the name “mirror cells”.

The reactive background cells are lymphocytes, plasma cells and eosinophils.

Diagnosis: Hodgkin lymphoma

Causes:

• Not well known. EBV plays a role

Note that the small cells in the background are not tumor cells but reactive immune cells.