Types of Hodgkin lymphoma
The World Health Organization (WHO) classifies HL into 5 subtypes – 4 are referred to as classic HL and 1 is classified separately as nodular lymphocyte-predominant HL. These classifications are based on what the lymphoma cells look like under a microscope. This includes the type of lymphoma cells, how they are organized and other characteristics that are seen in the sample from the lymph node.
The different types of HL can start in lymph nodes in different parts of the body and can affect people at different ages. Some types are more likely to cause B symptoms, which are unexplained fever of 38°C or higher, drenching night sweats and unexplained weight loss of more than 10% of body weight over the last 6 months.
Classic Hodgkin lymphoma
About 95% of all HLs are classic HL. The 4 subtypes all have Hodgkin and Reed-Sternberg (HRS) cells.
Nodular sclerosis HL
Nodular sclerosis HL (NSHL) is the most common type of HL. It accounts for 60%–80% of all cases of HL. NSHL occurs equally in men and women. It usually develops in teens and young adults 15–35 years of age.
NSHL usually starts in lymph nodes in the neck or chest and is most often diagnosed at stage 2. It causes B symptoms in 30%–40% of people.
Mixed cellularity HL
Mixed cellularity HL (MCHL) is the second most common type of HL. It accounts for 15%–30% of all cases of HL. It is most often seen in older adults and is the type of HL that most often develops in people with HIV infection.
MCHL can start in any lymph node. It usually develops in the upper half of the body and generally affects lymph nodes in the abdomen and the spleen. It is often advanced when it is diagnosed and usually causes B symptoms.
Lymphocyte-rich classic HL
Lymphocyte-rich classic HL (LRHL) accounts for about 5% of all cases of HL. It is more common in older people and develops more often in men.
LRHL usually develops in lymph nodes in the neck, in the armpits and above the collarbone. It is most often diagnosed at an early stage (stage 1 or 2) and it rarely affects more than a few lymph nodes. It doesn’t usually cause B symptoms.
Lymphocyte-depleted HL (LDHL) is the least common type of HL. It accounts for only about 1% of all cases of HL. It is more common in older people and develops more often in men. It may be seen in people with HIV infection.
LDHL usually affects lymph nodes in the abdomen and the spleen, liver and bone marrow. It is often advanced when it is first found and most people have B symptoms.
Nodular lymphocyte-predominant Hodgkin lymphoma
Nodular lymphocyte-predominant HL (NLPHL) accounts for about 5% of all HL cases. This type of HL has abnormal cells called LP cells, which may also be called popcorn cells because of how they look when viewed under a microscope. (These cells used to be called lymphocytic and histiocytic, or L&H, cells.) There may be very few or no HRS cells in the sample from the lymph node.
NLPHL can occur at any age, but it is most common in young men. It usually starts in lymph nodes in the neck and armpit. It is usually slow growing, or indolent, and diagnosed at an early stage. Most people don’t have symptoms other than enlarged lymph nodes in the neck, armpits or groin. B symptoms are rare.