[Hodgkin's disease: a mystery is being solved]

The cell lineage derivation and type of proliferation (monoclonal versus polyclonal) of the atypical cells in Hodgkin's Disease (HD) has remained in question up until now. Immunophenotypic studies favoured a lymphoid origin. Molecular biological studies using DNA extracted from whole biopsy material provided inconsistent results, probably due to the rarity of the atypical cells in the affected tissue. Hence the molecular biological studies were extended to the analysis of isolated atypical cells. However, even these single cells studies yielded conflicting results. We therefore have improved the technique of single cell isolation from tissue sections and applied it to 25 cases of classical HD and 11 cases of lymphocyte predominant HD (LPHD). We investigated a total of 1,465 single atypical cells for rearranged Ig variable-region chain (V) genes. In all instances in which the single cell DNA lead to a PCR amplification product, these were found to contain identical rearranged V region genes. All of these V region gene sequences proved to be highly mutated. The coding capacity of the rearranged Ig genes was frequently disrupted in classical HD but rarely in LPHD. The V sequences of the latter histotype showed in addition intra-clonal diversity in the majority of patients whereas this was not seen in all but one case of classical HD. Additionally, in 10 to 20% of classical HD cases T-cell antigens and/or cytotoxic molecules could be demonstrated in the atypical cells. These results indicate that, a) the atypical cells of LPHD are a clonal population of neoplastic germinal centre B cells; b) the atypical cells from 80-90% of classical HD cases represent a clonal expansion of B cells which are related to germinal centre B cells or their progeny; and c) the atypical cells of 10-20% of classical HD may originate from T cells.