[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [General pathology](https://durgical.com/en/general-pathology/) › [White cells, lymph nodes, spleen and thymus](https://durgical.com/en/general-pathology/areas/hematolymphoid/) › Hodgkin lymphoma

# 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.

Updated Nov 12, 2026

## Key points

- Classic Reed–Sternberg cell: large, binucleate or bilobed, each nucleus with a huge eosinophilic nucleolus ('owl eyes').
- Classic HL phenotype: CD15 and CD30 positive, PAX5 weak, CD45 and CD20 negative.
- Nodular sclerosis (commonest): young adults, mediastinum, lacunar cells, collagen bands; equal in men and women.
- Mixed cellularity: older men, systemic symptoms, plentiful RS cells, EBV in most cases.
- Pathogenesis: NF-κB activation (EBV LMP-1 or mutations) and gains of 9p24 (PD-L1/PD-L2) that switch off T cells.

On this page

- The basics Key points
- What it is
- Structure
- Step by step
- Hodgkin lymphoma subtypes, and how Hodgkin differs from non-Hodgkin
- Markers
- Memory aid
- Elsewhere in DurgiPedia

- Clinical Clinical notes

- Study Test yourself

- Connections Connections

## 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](https://durgical.com/en/conditions/hodgkin-lymphoma/) | Adolescents and young adults, both sexes | Lacunar cells | Collagen bands, mediastinal and supraclavicular nodes | Uncommon |
| [Mixed cellularity](https://durgical.com/en/conditions/hodgkin-lymphoma/) | Older men | Many classic RS cells | Eosinophils, plasma cells, B symptoms | Most cases |
| [Lymphocyte-rich](https://durgical.com/en/conditions/hodgkin-lymphoma/) | Older adults | Classic RS cells | Mainly reactive lymphocytes; very good outlook | About 40% |
| [Lymphocyte-depleted](https://durgical.com/en/conditions/hodgkin-lymphoma/) | 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.

## Memory aid

Owl eyes in a crowd: CD15 and CD30 light up, the crowd is reactive, and the spread goes node to neighbour.

## 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.

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## Elsewhere in DurgiPedia

- [B-cell activation, class switching and affinity maturation](https://durgical.com/en/immunology/b-cell-activation-class-switching-and-affinity-maturation/)
- [Eosinophil](https://durgical.com/en/immunology/eosinophil/)

## Connections

## Related 4

- [Reactive lymphadenitis: the patterns](https://durgical.com/en/general-pathology/reactive-lymphadenitis-the-patterns/)
- [Nodal T-cell lymphomas](https://durgical.com/en/general-pathology/nodal-t-cell-lymphomas/)
- [How tumours evade the immune system](https://durgical.com/en/general-pathology/how-tumours-evade-the-immune-system/)
- [Oncogenic viruses and H. pylori: the table to know](https://durgical.com/en/general-pathology/oncogenic-viruses-and-h-pylori-the-table-to-know/)

## Related conditions 4

- [Hodgkin lymphoma](https://durgical.com/en/conditions/hodgkin-lymphoma/)
- [Non-Hodgkin lymphoma](https://durgical.com/en/conditions/non-hodgkin-lymphoma/)
- [Mediastinal masses (thymoma and anterior mediastinal mass)](https://durgical.com/en/conditions/mediastinal-masses/)
- [Infectious mononucleosis](https://durgical.com/en/conditions/infectious-mononucleosis/)

## Microorganisms 1

- [Epstein–Barr virus](https://durgical.com/en/microbiology/epstein-barr-virus/)

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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](https://www.cancer.gov/types/lymphoma/patient/adult-hodgkin-treatment-pdq) (National Cancer Institute (NCI), 2026).

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Representative model, for educational purposes only.

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