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The Pathology and Nomenclature of Hodgkin's Disease

Department of Pathology, University of Southern California, School of Medicine, Los Angeles, California (R. J. L.) and Department of Pathology, M. D. Anderson Hospital, Houston, Texas (J. J. B.)

The diverse morphologic expressions of Hodgkin's disease have been reviewed and compared to the numerous histologic terms in the literature and the author's recently proposed histologic types. The relationship of the histologic findings to the clinical stages and survival has also been analyzed. The histologic expressions of the Hodgkin's disease process appear to be separable into the following 6 groups: (a) lymphocytic and/or histiocytic (L & H),¹ nodular; (b) lymphocytic and/or histiocytic (L & H), diffuse; (c) nodular sclerosis; (d) mixed; (e) diffuse fibrosis; and (f) reticular. The L & H types represent essentially a predominant lymphocytic proliferation with histiocytes, while diffuse fibrosis and reticular are associated with lymphocytic depletion. Nodular sclerosis has a remarkably high incidence of mediastinal involvement when initially observed, exceeding all other types combined, and appears to represent a regional expression of Hodgkin's disease in the mediastinum. The mixed type appears to reflect a changing disease state. These histologic types, with the exception of nodular sclerosis, represent differences in the frequency of lymphocytes and Reed-Sternberg cells and serve to emphasize their inverse relationship. The histologic findings are regarded as reflections of differences in the state of the host responsiveness and are believed to be related to the recently described immunologic defect. The demonstrated relationship between these histologic types, and the clinical stages and survival, provides further support for the importance of host factors and also presents an effective basis for prognostication. In addition a new histologic type, nodular sclerosis, has emerged as the most important prognostic type when observed in clinical Stage I.

The majority of the terms proposed in the literature for the histologic types of Hodgkin's disease represent designations for the lesion with a predominantly lymphocytic proliferation of either nodular or diffuse type. This lesion is of prognostic significance, but it includes only a small proportion of the prolonged survivors. The classical histologic types of Jackson and Parker are of limited effectiveness in prognosis since the heterogeneous granuloma group includes 80–90% of reported series, contains 79% of the survivors at 15 years in our study, and yet has a relatively short median survival in our comparison study.

¹ The groups designated lymphocytic and/or histiocytic will be referred to as "L & H" hereafter with the modification of the nodular or diffuse type.

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