<B>Hodgkins Disease, N.O.S. </B>

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Hodgkins Disease, N.O.S.

Etiology:

• Unknown

Pathogenesis:

• Very small population of neoplastic cells of L(ymphocyte) and H(istiocytic) subtype
• Marked inflammatory reaction driven by cytokines secreted by neoplastic cells including IL 5 (attracting eosinophils), IL4, tumor necrosis factor alpha, GM-CSF

Epidemiology:

• 0.7% of all new cancers in the U.S. overall
• Average age 32 years old

General Gross Description:

• Nodes may range from small to large and are fleshy
• Some variants show nodularity (LP and NS)
• Some variants show fibrosis (LD and NS)

General Microscopic Description:

• Four major types: nodular sclerosing, lymphocyte predominant, mixed cellularity, and lymphocyte depleted
• All contain diagnostic binucleate Reed-Sternberg cells with eosinophilic macronucleoli
• Mononuclear Reed-Sternberg variants differ from subtype to subtype
• Background is a mixture of lymphocytes, plasma cells and eosinophils depending on subtype

Clinical Correlations:

• Most present in cervical lymph nodes
• Spread to continguous nodal groups
• Generally very responsive to chemotherapy +/- radiation

References:
• Jaffe ES, Surgical Pathology of the Lymph Nodes and related organs, second edition, W.B. Saunders; Philadelphia, 1995, pp. 141-178