Hodgkin's lymphoma: histological classification and prognosis

Hodgkin's lymphoma is a malignant proliferation of lymphocytes characterised by the presence of the Reed-Sternberg cell. It has a bimodal age distributions being most common in the third and seventh decades

Histological classification

Type _ Frequency _ Prognosis _ Notes| Nodular sclerosing _ Most common (around 70%)_ Good prognosis _ More common in women. Associated with lacunar cells| Mixed cellularity _ Around 20% _ Good prognosis _ Associated with a large number of Reed-Sternberg cells| Lymphocyte predominant_ Around 5% _ Best prognosis _ | Lymphocyte depleted_ Rare _ Worst prognosis _ | 'B' symptoms also imply a poor prognosis

• weight loss > 10% in last 6 months
• fever > 38ºC
• night sweats

Other factors associated with a poor prognosis identified in a 1998 NEJM paper included:

• age > 45 years
• stage IV disease
• haemoglobin < 10.5 g/dl
• lymphocyte count < 600/µl or < 8%
• male
• albumin < 40 g/l
• white blood count > 15,000/µl