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Hodgkin Lymphoma

*Granuloma malignum*

For medical students2 min readUpdated 2026-10-10

Hodgkin lymphoma (formerly lymphogranulomatosis) is a malignant lymphoproliferative disorder characterized by the disruption of lymph node architecture and the appearance of specific neoplastic cells. Diagnosis is established strictly based on tissue morphological examination.

DiagnosisBased on the identification of Reed-Sternberg cells in the biopsy specimen.
EtiologyIn 70% of cases, the Epstein-Barr virus genome is detected in tumor cells.
Cell of OriginPresumed to be transformed germinal center B lymphocytes.
Age PeaksAround 30 years and in the elderly population.

Morphological Markers

The key diagnostic feature of the disease is the presence of Reed-Sternberg cells. These are large cells with a characteristic structure:

Specific variants also exist: Hodgkin cells (mononuclear), lacunar cells (with vacuoles), and L- and H-type cells ("popcorn cells").

Reactive Microenvironment

The neoplastic process is accompanied by a marked reaction of the surrounding tissues. The lymph node demonstrates:

  1. Complete effacement of normal follicles.
  2. Disruption of the normal node architecture.
  3. A polymorphic cellular infiltrate including lymphocytes, plasma cells, histiocytes, eosinophils, and neutrophils.
  4. Development of fibrosis of varying severity.

Prognosis and Survival

Treatment success directly depends on timely therapy. With appropriate management, the 5-year survival rate for early stages (I–II) approaches 100%, whereas for stage IV it is about 50%. The main causes of adverse outcomes remain disease progression and complications from aggressive treatment.

Mnemonic

"Owl in a lacuna": if you see a cell with two nuclei-eyes (Reed-Sternberg) or a cell in an empty space (lacunar) — think Hodgkin lymphoma.

Frequently asked questions

What histological variants of Hodgkin lymphoma are distinguished in modern morphological classification?

The modern WHO classification distinguishes two main types of Hodgkin lymphoma: classical and nodular lymphocyte-predominant.

Histological variants of classical Hodgkin lymphoma:

  • Nodular sclerosis variant — includes types I and II.
  • Mixed cellularity variant.
  • Lymphocyte-rich classical variant (lymphocyte-rich).
  • Lymphocyte depletion variant — is rare.

Nodular lymphocyte-predominant Hodgkin lymphoma is classified as a distinct type with a different pathogenesis and immunophenotype.

What is the macroscopic appearance of the spleen in Hodgkin lymphoma?

Macroscopically, Hodgkin lymphoma forms the so-called "porphyry spleen." The spleen is enlarged and firm. On cross-section, red pulp is seen mottled with white-yellow foci and streaks.

In which organs are extranodal lesions and metastases most frequently found during the generalization of Hodgkin lymphoma?

During the generalization of Hodgkin lymphoma, the spleen, liver, lungs, bone marrow, stomach and other parts of the gastrointestinal tract, skin, and kidneys may be involved. Primary extranodal localization in the spleen, liver, lungs, stomach, skin, and bone marrow is otherwise considered rare.

What pathological processes and complications are most often the direct cause of death in patients with Hodgkin lymphoma?

The direct causes of death in patients with Hodgkin lymphoma are most often progression of the underlying disease and complications of therapy.

Main pathological processes and complications:

  • Disease progression — generalization of the process with involvement of internal organs, development of cachexia, and multiorgan failure.
  • Complications of chemotherapy and radiation therapy — toxic effects on organs, development of secondary malignancies.
  • Infectious complications — sepsis, septic shock, and pneumonia against the background of secondary immunodeficiency.
  • Critical conditions — acute respiratory failure, acute kidney injury, cerebrovascular accidents, gastrointestinal bleeding, and tumor lysis syndrome.
Why are Reed-Sternberg cells called "owl eyes"?

Due to the presence of two symmetrical nuclei with large nucleoli, which visually resemble the eyes of an owl.

What is the role of the Epstein-Barr virus in pathogenesis?

The viral genome is detected in tumor cells in 70% of patients, indicating its involvement in cellular transformation.

What is the diagnostic value of Hodgkin cells?

They are mononuclear variants of Reed-Sternberg cells and help identify tumor metastases in the liver and bone marrow.

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