7.4.5Histological Classification (WHO)

Classic Hodgkin disease: predominance of T-cell lines and frequency

•Nodular sclerosing: common in adolescents together with mediastinal enlargement; lymphoid tissue separated by collagen bands: 68%

•Lymphocyte-depleted: usually advanced stage of disease: <1%

•Mixed cellular: pleomorphic with high cellularity. Diffuse fibrotic type with few Reed–

Sternberg cells. Reticular type with pleomorphic anaplastic Reed–Sternberg cells, also called “Hodgkin sarcoma,” with often more rapid progression and unfavorable prognosis: 21%

•Lymphocyte-rich: 1%

Nodular lymphocyte-predominant Hodgkin disease: predominance of B-cell line and frequency

•Often stage IA with cervical node involvement

•Favorable prognosis

•Subgroups of lymphocyte-rich and nodular lymphocyte-predominant Hodgkin disease: 9%

•Lymphoma with nodular structure, also called “nodular paragranuloma”

7.4.6Approximate Frequency of Histological Subtype and Stage

•Correlation between histological subtype and age of patients:

–Small children: often nodular lymphocyte-predominant Hodgkin disease, rarely lymphocyte-depleted Hodgkin disease

–Children and adolescents: mostly nodular sclerosing or mixed cellular Hodgkin disease

7.5Staging Classification

7.5.1Ann Arbor Staging Classification

•I: involvement of a single lymph node region (I) or of a single extralymphatic organ site (IE)

•II: involvement of two or more lymph node regions on the same side of the diaphragm (II) or localized involvement of an extralymphatic organ or site and one or more lymph node regions on the same side of the diaphragm (IIE)

•III: involvement of lymph node regions on both sides of the diaphragm (III),

which may be accompanied by involvement of the spleen (IIIS) or by localized involvement of an extralymphatic organ (IIIE) or site or both (IIIES)

•IV: diffuse or disseminated involvement of one or more extralymphatic organs or tissues with or without associated lymph node involvement