Hodgkin’s Disease Pathophysiology

Reed-Sternberg Cell

The pathophysiology of a disease is a description of how it grows and moves through the body. Hodgkin's disease has a special way of spreading.

Hodgkin's disease is different from other lymphomas because of the presence of a special cell, the Reed-Sternberg cell. In most lymphomas, cancer cells make up most of a tumor. In Hodgkin's disease, the Reed-Sternberg cells only make up a small part of the cells in a cancerous lymph node. The rest of the cells are normal.

Scientists now conclude that Hodgkin's disease is not a single disease with different types. Rather, Hodgkin's disease represents a group of at least two diseases. The two primary classifications of HD are: "classic" Hodgkin's disease (cHD), and lymphocyte-predominant Hodgkin's disease (LPHD).

Each type of Hodgkin's disease tumor grows in slightly different ways.

Classical Hodgkin's Disease:

• Nodular Sclerosis (NS). Nodular Sclerosis (NS) almost always appears in people between the ages of 15 and 35, and is much more common in women than in men. Most people with NS don't have any initial symptoms. When the disease is found, it is usually at Stage I or II.

• Lymphocyte Rich (LR). Lymphocyte Rich (LR) Hodgkin's disease is usually found in people in their 30s and 40s. More men than women get LP Hodgkin's disease, and the cure rate is very high. B symptoms are very uncommon in LP Hodgkin's.

• Mixed-Cellularity (MC). Mixed-Cellularity (MC) Hodgkin's can be found in all age groups, but is most common in people in their 30s and 40s. It is more common in men, and most people aren't diagnosed until the disease is in stage III or IV. B symptoms are very common, and often help the doctor diagnose the disease.

• Lymphocyte Depleted (LD). Lymphocyte Depleted (LD) Hodgkin's disease is the most aggressive Hodgkin's disease. More Reed-Sternberg cells are present in the lymph nodes of someone with LD Hodgkin's disease than in any other type. There are two types of LD Hodgkin's disease: reticular and diffuse fibrosis. People with reticular LD usually have some cancer invading their bone marrow. Those with diffuse fibrosis usually have more cancer in the lymph nodes themselves, and in surrounding body tissue. LD Hodgkin's disease is more common in older men.

• Nodular Lymphocyte Predominant Hodgkin's disease (nLPHD), makes up about 5 percent of all Hodgkin's disease cases. It is three times more common in men than in women, and it usually affects young adults between their 30s-50s. Most patients are diagnosed at an early stage and a majority respond to therapy with a complete response. Classic Reed-Sternberg cells are not seen or are very uncommon in patients' tissue samples. Instead, large, circular meshworks of cells take over the lymph nodes. Late relapses are common, but they usually do not affect survival. The survival rate is favorable even among patients with recurrent disease.