Hematologic neoplasms
Hodgkin lymphoma

Author: Sheren Younes, M.D. (see Authors page)

Revised: 31 October 2016, last major update November 2013

Copyright: (c) 2003-2016,, Inc.

PubMed search: hodgkin lymphoma [title] in bone

Cite this page: Hodgkin lymphoma. website. Accessed December 17th, 2018.
Definition / general
  • Hodgkin lymphoma (HL) is primarily a nodal disease - secondary involvement of bone can occur, is considered as Stage IV
  • Primary bone HL is extremely rare (Ann Oncol 2008;19 Suppl 4:iv77)
  • Defined according to WHO criteria for primary bone lymphoma (PBL), as lymphoma presenting in an osseous site with no evidence of disease elsewhere for at least 6 months
  • Involvement of regional lymph nodes does not exclude diagnosis of PBL (Joint Bone Spine 2000;67:446)
  • Bimodal age distribution, peaks in young adults and later stages of life
  • Male to female ratio is slightly > 1
  • Associated with EBV (40% - 50% of cases, specific role not established)
  • Also linked to HLA, associated with HIV infection, autoimmune disease, immunocompromise
Clinical features
  • Bone pain, pathologic fracture, mass
  • Neurologic symptoms in vertebral involvement
  • Systemic symptoms ("B" symptoms) of fever, night sweats, weight loss
  • Elevated ESR, elevated LDH
  • Variable anemia
Radiology description
  • Bone lesions are variable and non specific; may be lytic destructive, blastic sclerotic, or near normal patterns (Radiographics 2003;23:1371)
  • Vertebral lesions spread from bone to bone, with intervertebral disc destruction
  • CT and other radiologic studies useful for staging
Radiology images
Images hosted on PathOut server:

Osteoblastic involvement

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Osteolytic lesion

Increased uptake in the sternum

Sternal mass

Destruction of L1 vertebra

Loss of height of L1

Prognostic factors
  • Stage of disease
  • Systemic symptoms
  • Tumor burden (bulky disease if > 10 cm)
  • International Prognostic Score (IPS)
Case reports
  • Combination of chemotherapy and radiotherapy
Microscopic (histologic) description
  • Characteristic combination of Hodgkin Reed-Sternberg (HRS) cells (diagnostic cells), in background of mixed inflammatory cells
  • HRS cells are large, binucleate or multinucleate cells, with thick nuclear membrane, gigantic eosinophilic inclusion surrounded by halo
  • Variants:
    • Mononuclear
    • Lacunar (lobulated nuclei and retracted cytoplasm in formalin-fixed tissue)
    • Pleomorphic (large bizarre nuclei)
    • Mummified cells (discernible nuclear features and eosinophilic cytoplasm)
  • Infiltrate of lymphocytes, plasma cells, histiocytes, eosinophils, and neutrophils
  • Most common patterns are mixed cellularity (classic mononuclear HRS cells), and nodular sclerosing pattern (lacunar cells)
  • May show accompanying fibrosis, granuloma
Microscopic (histologic) images
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Scattered lacunar cells

Mixed inflammatory cells


Cytology description
  • Spectrum of HRS cells in reactive inflammatory background
  • Granulomas may be seen
Peripheral smear description
  • Rouleaux formation, due to elevated ESR
  • Neoplastic cells of HL rarely circulate in peripheral blood
Positive stains
Negative stains
Flow cytometry description
  • Flow cytometry has no diagnostic value for HL itself, but may assist with differential diagnosis if cytology is not conclusive
  • Recently, HRS-T cell rosettes identified by flow cytometry (Am J Clin Pathol 2006;126:764)
Electron microscopy description
Molecular / cytogenetics description
  • Gain of chromosome 2p, 12q, 17p, 9p, and 16p
Differential diagnosis