Histology

For a precise classification of Hodgkin lymphomas according to the GHSG standard, it is decisive to perform a histologic tumor tissue examination and to determine the lymphoma dissemination throughout the body (stage of disease) and the presence or absence of certain risk factors (see below). Hodgkin lymphoma is divided into early, intermediate and advanced stages and treatment is adapted to these stages.

Histology of tumor cells

The neoplastic Hodgkin lymphoma cells – the Hodgkin and Reed-Sternberg cells and their variants – have a typical morphology. The Hodgkin lymphoma infiltrate contains only a few of these cells (approx. 1%), but a large amount of non-malignant cells, such as T- and B‑lymphocytes, macrophages and eosinophil granulocytes.

Hodgkin lymphomas can be diagnosed and histologically classified by means of a tissue examination. The WHO classification differentiates between classical Hodgkin lymphoma (approx. 95% of cases) and nodular lymphocyte-predominant Hodgkin lymphoma (approx. 5% of cases). The latter is considered as an independent disease entity.

Classical Hodgkin lymphoma is divided into four histologic subtypes.

Nowadays, the histologic subtypes of Hodgkin lymphoma do not influence the choice of treatment anymore. However, it should be mentioned that nodular lymphocyte-predominant Hodgkin lymphoma at stage IA (only one affected lymph node region) has such a favorable course compared to other types at stage I that it is only treated with involved-field radiotherapy.