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Hodgkin Lymphoma - Subtypes

A lymphoma is classified as Hodgkin lymphoma if the Reed-Sternberg cell is detected. However, Hodgkin lymphoma is further classified into subtypes which describe the disease in more detail such as what the affected lymph nodes look like, what other cells are present and what characteristics the cells have.

Subtypes of Hodgkin lymphoma include:

Classical Hodgkin lymphoma - Nodular sclerosis:

Nodular Sclerosis CHL is the most common subtype of HL, accounting for 60 to 80 percent of all HL cases. In nodular (knot-like) sclerosis CHL, the involved lymph nodes contain RS cells mixed with normal white blood cells. The lymph nodes often contain a lot of scar tissue, which is where the name nodular sclerosis (scarring) originates. The disease is more common in women than in men, and it usually affects adolescents and adults under the age of 50. Many patients can be cured with current treatments.

Classical Hodgkin lymphoma - Lymphocyte-rich:

Lymphocyte-Rich CHL accounts for less than five percent of HL cases. The disease may be diffuse (spread out) or nodular in form and is characterized by the presence of numerous normal-appearing lymphocytes and classic RS cells. This subtype of HL is usually diagnosed at an early stage in adults and has a low relapse (disease returns after treatment) rate.

Classical Hodgkin lymphoma - Mixed cellularity:

Mixed Cellularity CHL accounts for about 15 to 30 percent of all HL cases. The disease is found more commonly in men than in women, and it primarily affects older adults. With this type of CHL, the lymph nodes contain many RS cells in addition to several other cell types. More advanced disease is usually present by the time this subtype is diagnosed.

Classical Hodgkin lymphoma - Lymphocyte-depleted:

Lymphocyte-Depleted CHL is rarely diagnosed. Abundant Reed Sternberg (RS) cells and few normal lymphocytes are present in the lymph nodes of patients with this subtype, which is aggressive and usually not diagnosed until it is widespread throughout the body.

Classical Hodgkin lymphoma

(Not otherwise specified)

Nodular lymphocyte predominant Hodgkin lymphoma:

About 1 in 20 Hodgkin lymphomas diagnosed (5%) are NLPHL. It tends to grow more slowly and to be diagnosed earlier, when it is only growing in one or two groups of lymph nodes. The lymph nodes it grows in tend to be in places that can be easily felt, rather than deep inside the body. For these reasons, treatment is usually very successful and many people are cured.

 

Staging Hodgkin lymphoma

"Staging" is a medical term used to describe the extent to which the lymphoma has spread within the body. The stage is determined by:

  • The number and location of lymph nodes affected.
  • Whether the affected lymph nodes are above, below or on both sides of the diaphragm (the large, dome-shaped muscle under the ribcage that separates the chest from the abdomen).
  • Whether the cancer has spread to the bone marrow or to other organs such as the liver.

 

 A diagramattical example of the path of Hodgkin Lymphoma using
the Ann Arbor Staging System. 

The most common method of staging is called the Ann Arbor Staging System, which can be summarised as follows:

Ann Arbor Staging System 

NHL Stage What it means

1

The HL is in only one group of lymph nodes

2

Two or more groups of lymph nodes are affected but they are all either above or below the diaphragm, either all in the chest or all in the abdomen

3

Two or more groups of lymph nodes are affected in both the chest and the abdomen

4

HL is in at least one organ (e.g. bone marrow, liver or lungs) as well as the lymph nodes


Each stage of Hodgkin lymphoma may also be classified as "A" or "B". People with a B classification have one or more of the following B symptoms:

  • Unexplained weight loss of more than 10% in the six months before diagnosis
  • Unexplained fever with temperatures above 38°C
  • Drenching night sweats

For example, if your Hodgkin lymphoma is on both sides of your diaphragm and you have been having night sweats, the doctor will refer to your disease as stage 3B. Or, if your disease is in several lymph nodes above your diaphragm (e.g. your neck and chest) and you have no B symptoms, your doctor will refer to your disease as stage 2A.

Medical tests for staging Hodgkin lymphoma

In addition to a lymph node (and perhaps also a bone marrow) biopsy, the doctor may require that you have other medical tests to identify the stage of disease. Some of these tests may include images and scans, such as:

X-ray

  • A procedure where low dose radiation beams are used to provide images of the inside of the body for diagnostic purposes.

CT scan/CAT scan

  • A series of X-rays that provide detailed, three-dimensional images of the inside of the body.

MRI (magnetic resonance imaging)

  • An MRI is similar to a CT scan, but uses magnets instead of X-rays.

Gallium scan

  • A safe amount of radioactive gallium is injected into the person, after which an X-ray is performed to detect where the radioactive gallium makes the tumour(s) visible.

PET (positron emission tomography) scan

  • This is similar to a Gallium scan, except it is radioactive glucose which is injected into the person and is taken up preferentially by cells with a high metabolic (energy) activity, such as cancer cells. A scanner is then used to visualise the areas of the body where the radioactive glucose is concentrated.