Classical Hodgkin Lymphoma

Classical Hodgkin Lymphoma

Francisco Vega, MD, PhD

Classical Hodgkin lymphoma (CHL) involving the spleen characterized by an infiltrate image of large tumor cells in a background of inflammatory cells and fibrosis. Uninvolved spleen is also seen image.

PET scan shows widespread CHL throughout the abdomen and pelvis. There is also enlargement of the spleen image and liver image due to lymphoma involvement.



  • Classical Hodgkin lymphoma (CHL)


  • Hodgkin disease


  • Splenic involvement by CHL



  • > 80% of patients with CHL present with lymphadenopathy above diaphragm

    • Most common: Cervical, supraclavicular, and axillary lymph nodes

  • 1/3 of patients present with B symptoms: Fever, night sweats, weight loss

  • CHL can involve extranodal tissues

    • Common: Spleen, lungs, liver, and bone marrow

    • Primary splenic CHL is extremely rare

  • Splenic involvement

    • 37% of patients have splenic involvement (mean from 17 published case series)

    • Splenic involvement is associated with bone marrow and liver involvement

  • Staging laparotomy in CHL patients was performed in past

  • Nowadays, staging laparotomy is no longer performed, mainly because

    • Routine use of chemotherapy is independent of stage (replacing wide-field radiotherapy)

    • Improvement of imaging studies

      • Positron emission tomography (PET) with fluorodeoxyglucose 18F (standard staging tool)


  • Drugs

    • Chemotherapy

      • Adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD) is standard regimen


  • CHL staging

    • According to Ann Arbor criteria modified at Cotswolds meeting

  • Extranodal disease is adverse prognostic factor for localized CHL according German Hodgkin Lymphoma Study Group (GHLSG)



  • Spleen may be large or normal size

  • Variable patterns of splenic involvement

    • Multiple nodules, isolated or confluent (most common)

    • Solitary nodule

    • Miliary small nodules

Jul 8, 2016 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Classical Hodgkin Lymphoma

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