What are the histologic classes of Hodgkin’s disease?
- Nodular sclerosis is the most common type, accounting for 35% of all patients with Hodgkin’s disease. It is more common in women and has a relatively good prognosis. It is characterized by a particular type of Reed-Sternberg cell, called the lacunar cell, which is a large cell with a hyperlobulated nucleus and multiple nucleoli surrounded by a clear space (lacunae).
- Mixed cellularity represents a histologic type that is intermediate between lymphocyte-predominance and lymphocytedepletion types. It is the second most common type. Reed-Sternberg cells are prominent.
- Lymphocyte-predominance type has a diffuse or slightly nodular histologic pattern (popcorn pattern). Reed-Sternberg cells are rare. It is the most common pattern found in young men, and the prognosis is excellent. The anti–CD20 monoclonal antibody, rituximab, which is usually used in non–Hodgkin’s lymphoma, has been shown to produce over a 50% complete response rate for this subtype of Hodgkin’s disease.
- Lymphocyte-depletion pattern is characterized by a paucity of lymphocytes and numerous Reed-Sternberg cells or their variants. There is a diffuse fibrotic and a reticular variant of the lymphocyte-depleted subtype. This type tends to occur in older patients, with disseminated involvement and a poor prognosis.
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