Pathophysiology of HL
Diagnostic Testing
100
What is the most common type of HL?
Nodular Sclerosis
Bonus Question: What lymph node(s) does Nodular Sclerosis HL present in first?
100
According to WHO, what is absolutely necessary for the definitive diagnosis for lymphoma?
Answer: Lymph node biopsy (or tissue biopsy depending on presentation of lymphoma)
200
What is the precursor to Reed-Steinberg cells?
B-lymphocytes (in germinal centers)
200
What does a high ESR indicate?
Answer: Inflammation in the red blood cells
Bonus question: How is the ESR measured? What is the difference between ESR & CRP?
300
Theorize - How does EBV lead to potential increase in Hodgkin’s Lymphoma?
EBV infects B-cells, leading to insertion of genome and proliferation/mutation in B-cells to proliferate RS cells
300
Point to both your left supraclavicular lymph node and right axillary lymph node.
What is the supraclavicular lymph node in between? What about the axillary lymph node?
400
List the five types of Hodgkin’s Lymphomas and one histological characteristic that makes them unique from the other subtypes.
Classical
Nodular Sclerosis - fibrous bands, lacunar cells
Lymphocyte rich - Increase in mature lymphocytes, low amount of RS cells
Mixed cellularity - no fibrous bands, premature RS cells + inflammatory infiltrates
Lymphocyte depleted - low mature lymphocytes; high RS cells
Non-classical
Lymphocyte Predominant - No RS cells, but popcorn cells (giant, multilobed nucleus)
500
A 28-year-old female presents with a 3-month history of painless swelling in her neck and intermittent fever, night sweats, and weight loss.
Fast forward a week later, you have told the unfortunate news to the same patient that they have been diagnosed with Nodular Sclerosis Hodgkin’s Lymphoma. The good news is that you caught it early and it looks like a good prognosis. Walk through how you came to this definitive diagnosis, and what you ordered.
WBC with differential: Normal
ESR: elevated
LDH: elevated
CRP: elevated
PBS: RS Cells
Lymph node biopsy: Lacunar cells + fibrous bands
Flow Cytometry: CD15+, CD30+