Hodgkin lymphoma
- Lesion
A lymphoma in which a few large tumour cells hide among many normal inflammatory cells. It spreads node to node and is usually curable.
What it is
Hodgkin lymphoma arises in a single node or chain and spreads to neighbouring nodes in an orderly way. The tumour cells, Reed–Sternberg cells and their variants, are derived from germinal centre B cells that have lost most B-cell features; they make up a small fraction of the mass and attract a large reactive population. Classic Hodgkin lymphoma has four subtypes; nodular lymphocyte-predominant disease is now regarded as a separate B-cell lymphoma. EBV is present in a subset, especially mixed cellularity.
Structure
- Reed–Sternberg cells and variants (lacunar cells in nodular sclerosis; mummified cells; popcorn or LP cells in the lymphocyte-predominant type).
- Background of small T cells, eosinophils, plasma cells and macrophages that outnumber the tumour cells.
- Nodular sclerosis: bands of collagen dividing the node into nodules.
Step by step
- A germinal centre B cell acquires crippling immunoglobulin mutations that should trigger its death.
- NF-κB activation (EBV LMP-1, loss of IκB or TNFAIP3) rescues it from apoptosis.
- The cell loses its B-cell programme and becomes a Reed–Sternberg cell.
- It secretes cytokines and chemokines that recruit T cells, eosinophils and fibroblasts.
- PD-L1 and PD-L2 on its surface paralyze cytotoxic T cells; the tumour spreads to contiguous nodes.
Hodgkin lymphoma subtypes, and how Hodgkin differs from non-Hodgkin
| Type | Who | Tumour cell | Background and clues | EBV |
|---|---|---|---|---|
| Nodular sclerosis | Adolescents and young adults, both sexes | Lacunar cells | Collagen bands, mediastinal and supraclavicular nodes | Uncommon |
| Mixed cellularity | Older men | Many classic RS cells | Eosinophils, plasma cells, B symptoms | Most cases |
| Lymphocyte-rich | Older adults | Classic RS cells | Mainly reactive lymphocytes; very good outlook | About 40% |
| Lymphocyte-depleted | Older adults, HIV, low-resource settings | Many pleomorphic RS cells | Few lymphocytes; advanced stage | Most cases |
| Hodgkin vs non-Hodgkin (overall) | Hodgkin: localized, contiguous spread, rarely extranodal | Non-Hodgkin: often multiple nodes, noncontiguous, extranodal and marrow common | Hodgkin: few tumour cells in a reactive sea; NHL: sheets of tumour cells | Hodgkin: often; NHL: subsets |
Markers
- CD15
- CD30
- PAX5 (weak)
- CD45 negative
- CD20 (LP cells)
Clinical notes
- Painless cervical or mediastinal lymphadenopathy; fever, night sweats and weight loss (B symptoms); itching; pain in nodes after alcohol.
- Cure rates are high; survivors face late second cancers (breast, lung, leukaemia) and heart disease from treatment.
- Nodular lymphocyte-predominant lymphoma: popcorn cells that are CD20 positive and CD15/CD30 negative.
Test yourself
Think of the answer, then tap the question to see it.
What is the immunophenotype of a classic Reed–Sternberg cell?
CD15 and CD30 positive, weak PAX5, negative for CD45 and most B- and T-cell markers.
Which subtype is most common and what are its features?
Nodular sclerosis: lacunar cells and collagen bands, typically in mediastinal nodes of young adults.
How do Reed–Sternberg cells escape immune attack?
They overexpress PD-L1 and PD-L2 (often through 9p24 gains), which switch off cytotoxic T cells.
Elsewhere in DurgiPedia
Connections
Microorganisms1
Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.
Sources: Hodgkin Lymphoma Treatment (PDQ®)–Patient Version (National Cancer Institute (NCI), 2026).
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Representative model, for educational purposes only.