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The interrelationship of Hodgkin's disease and non-Hodgkin's lymphomas--lessons learned from composite and sequential
E S Jaffe1, A Zarate-Osorno, L J Medeiros
1Hematopathology Section, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892.
Insights
Hodgkin's disease (HD) and non-Hodgkin's lymphoma (NHL) are more closely linked than previously thought. Analysis reveals composite lymphomas and sequential HD-NHL diagnoses occur frequently, suggesting a shared B cell origin.
Area of Science:
- Hematology
- Oncology
- Pathology
Background:
- Hodgkin's disease (HD) and non-Hodgkin's lymphoma (NHL) have traditionally been viewed as separate conditions.
- Emerging evidence suggests a significant association between HD and NHL.
Purpose of the Study:
- To investigate the frequency and nature of associations between HD and NHL.
- To explore the potential clonal relationship between these lymphoid malignancies.
Main Methods:
- Analysis of clinical cases with composite lymphomas (HD and NHL in the same site).
- Examination of simultaneous or sequential diagnoses of HD and NHL in separate sites.
- Review of histological features and cell phenotypes in associated cases.
Main Results:
- Composite lymphomas and sequential HD-NHL diagnoses occur more often than by chance.
- Nodular lymphocyte-predominant Hodgkin's disease (NLPHD) coexisting with large cell lymphoma (LCL) is common, indicating a B cell origin and potential progression.
- Other HD subtypes associated with NHL, predominantly B-cell lymphomas like follicular lymphoma, were also observed.
- An association between HD and B-cell chronic lymphocytic leukemia (CLL) was noted, with Reed-Sternberg cells in CLL suggesting a clonal relationship.
Conclusions:
- HD and NHL are more closely associated than previously recognized.
- These findings support a shared B cell origin for components in composite lymphomas and sequential HD-NHL cases.
- Reed-Sternberg cells in some HD cases may represent altered B lymphocytes, linking HD to underlying B cell malignancies.
Abstract:
While Hodgkin's disease (HD) and non-Hodgkin's lymphoma (NHL) have long been regarded as distinct disease entities, recent observations suggest a closer association. The analysis of cases in which these diagnoses are made in the same anatomic site (composite lymphomas) or in separate sites (simultaneous or sequential HD and NHL) indicates that this phenomenon occurs more frequently than would be expected by chance alone. The most common form of composite lymphoma is coexistent nodular lymphocyte-predominant Hodgkin's disease (NLPHD) and large cell lymphoma (LCL) of B cell phenotype. This finding is consistent with a B cell origin for the abnormal cells in NLPHD, suggesting that LCL represents a form of histologic progression, with the existence of a clonal relationship between the two components. The association of other forms of HD (nodular sclerosis or mixed-cellularity) and NHL is less common, but still significant. As with NLPHD and LCL, one may observe composite lymphomas, or the diagnosis of HD may precede or follow the diagnosis of NHL. The vast majority of NHLs associated with HD are of B cell origin, most commonly follicular lymphomas. An association between HD and B cell chronic lymphocytic leukemia (CLL) is also observed. In selected cases, Reed-Sternberg (RS) cells are seen in a background of otherwise typical CLL, and some of these patients have progressed to disseminated HD. These findings suggest that, at least in some cases, HD may be clonally related to an underlying B cell malignancy, and that the RS cell may be an altered B lymphocyte.(ABSTRACT TRUNCATED AT 250 WORDS)