Hodgkin lymphoma vs Non-Hodgkin lymphoma
How to tell Hodgkin lymphoma and Non-Hodgkin lymphoma apart when a board question makes them look alike.
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Reed-Sternberg cells on excisional biopsy identify Hodgkin lymphoma.
Side by side
Contiguous nodal spread with painless cervical adenopathy and Reed-Sternberg cells favors Hodgkin lymphoma.
Noncontiguous nodal or extranodal disease without Reed-Sternberg cells favors non-Hodgkin lymphoma.
Malignant B-cell derived Reed-Sternberg cells drive inflammatory nodal architecture changes.
Diverse malignant B-cell or T-cell clones cause variable nodal and extranodal proliferation patterns.
Excisional node biopsy shows classic Reed-Sternberg cells with CD15 and CD30 positivity; staging PET-CT defines contiguous spread pattern.
Biopsy reveals specific NHL subtype markers such as CD20-positive diffuse large B-cell lymphoma or follicular patterns, often with extranodal uptake on PET-CT.
The trap
Relying on fine-needle aspiration alone can miss architecture needed for lymphoma classification. Excisional biopsy is necessary before choosing treatment pathway.
The repair move
Next best step: obtain full staging with PET-CT and baseline labs, then start stage-appropriate chemotherapy regimen such as ABVD for classical Hodgkin lymphoma. For NHL, therapy depends on subtype and may include rituximab-based protocols such as R-CHOP for diffuse large B-cell disease.
Try a free question
CoreA patient with painless cervical adenopathy has excisional biopsy showing CD15-positive, CD30-positive Reed-Sternberg cells. What is the next best step in management?
Show answer and explanation
Answer: A. Stage with PET-CT and initiate Hodgkin-directed therapy. Confirmed Hodgkin lymphoma requires formal staging and stage-based chemotherapy planning.
Why the other choices are tempting
- B. Wrong. Infectious treatment alone is not appropriate for biopsy-proven lymphoma.
- C. Wrong. Additional staging determines treatment intensity.
- D. Wrong. Splenectomy is not first-line management.
- E. Wrong. Delaying therapy risks disease progression.
Flashcards
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Which biopsy finding is decisive for Hodgkin lymphoma?
Reed-Sternberg cells on excisional node biopsy.
What spread pattern is more common in Hodgkin lymphoma?
Contiguous nodal spread.
Quick answers
What is the fastest way to tell Hodgkin lymphoma from Non-Hodgkin lymphoma?
Reed-Sternberg cells on excisional biopsy identify Hodgkin lymphoma.
What is the key clue for Hodgkin lymphoma?
Contiguous nodal spread with painless cervical adenopathy and Reed-Sternberg cells favors Hodgkin lymphoma.
What is the key clue for Non-Hodgkin lymphoma?
Noncontiguous nodal or extranodal disease without Reed-Sternberg cells favors non-Hodgkin lymphoma.
What is the common trap with Hodgkin lymphoma vs Non-Hodgkin lymphoma?
Relying on fine-needle aspiration alone can miss architecture needed for lymphoma classification. Excisional biopsy is necessary before choosing treatment pathway.