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Medicina & Laboratorio

2023, Número 3

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Medicina & Laboratorio 2023; 27 (3)


Linfoma de Hodgkin clásico: diferentes caras, una misma entidad

Orejuela-Erazo J, Bedoya-López M, Díaz-Macea DR, Santiago-Pacheco V

Idioma: Español
Referencias bibliográficas: 57
Paginas: 245-261
Archivo PDF: 844.77 Kb.


RESUMEN

El linfoma de Hodgkin clásico es una neoplasia linfoide maligna derivada de las células B del centro germinal, que corresponde aproximadamente al 85 % de los casos de linfoma de Hodgkin. Esta entidad afecta principalmente a pacientes jóvenes, y cuenta con un excelente pronóstico gracias a los avances en los métodos diagnósticos para su estadificación y tratamiento. Su enfoque diagnóstico correcto y completo requiere de una historia clínica exhaustiva y una biopsia de ganglio linfático adecuada para el análisis e identificación de los hallazgos histopatológicos e inmunohistoquímicos característicos, ya que a diferencia de otros linfomas donde las células neoplásicas son una población importante o dominante, las células de Hodgkin y Reed-Sternberg generalmente representan menos del 10 % de la lesión tumoral. Aunque todavía falta mucho por entender sobre la naturaleza biológica de este linfoma y sus diferentes subtipos, en los últimos años se ha avanzado considerablemente en la comprensión de su linfomagénesis, especialmente cuando está relacionada con la infección por el virus de Epstein-Barr. Su alta heterogeneidad y posible superposición morfológica, obligan a continuar su estudio para poder identificarlo, al igual que a sus posibles diagnósticos diferenciales en aquellos casos donde se presente con una variante o patrón infrecuente. Este artículo pretende ofrecer una descripción integral resumida y actualizada sobre la fisiopatología, la clínica, el diagnóstico histopatológico con énfasis en aquellos patrones raros que podrían llegar a ser factores distractores y de confusión, y el pronóstico del linfoma de Hodgkin clásico, buscando lograr una mejor comprensión de la enfermedad.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Wang HW, Balakrishna JP, Pittaluga S, JaffeES. Diagnosis of Hodgkin lymphoma in themodern era. Br J Haematol 2019;184:45-59.https://doi.org/10.1111/bjh.15614.

  2. Küppers R. New insights in the biology ofHodg-kin lymphoma. Hematology Am Soc HematolEduc Program 2012;2012:328-334.

  3. World Health Organization (WHO). Globalhealth estimates 2020: Deaths by cause, age,sex, by country and by region, Hodgkin lymphoma,2000-2019. Ginebra, Suiza: WHO;2020.

  4. Huang J, Pang WS, Lok V, Zhang L, Lucero-Prisno DE, Xu W, et al. Incidence, mortality,risk factors, and trends for Hodgkin lymphoma:a global data analysis. J Hematol Oncol2022;15:57. https://doi.org/10.1186/s13045-022-01281-9.

  5. Singh D, Vaccarella S, Gini A, De Paula-SilvaN, Steliarova-Foucher E, Bray F. Global patternsof Hodgkin lymphoma incidence andmortality in 2020 and a prediction of the futureburden in 2040. Int J Cancer 2022;150:1941-1947. https://doi.org/10.1002/ijc.33948.

  6. Shenoy P, Maggioncalda A, Malik N, FlowersCR. Incidence patterns and outcomes for hodgkinlymphoma patients in the United States.Adv Hematol 2011;2011:725219. https://doi.org/10.1155/2011/725219.

  7. Borges AM, Delabie J, Vielh P. Classic Hodgkinlymphoma. In: Gujral S, Siebert R, de JongD, eds. WHO Classification of Tumours, EditorialBoard Haematolymphoid tumours. 5th ed. Lyon(France): International Agency for Research onCancer; 2022.

  8. Momotow J, Borchmann S, Eichenauer DA,Engert A, Sasse S. Hodgkin lymphoma-reviewon pathogenesis, diagnosis, current and futuretreatment approaches for adult patients. J ClinMed 2021;10:1125. https://doi.org/10.3390/jcm10051125.

  9. Shanbhag S, Ambinder RF. Hodgkin lymphoma:A review and update on recent progress.CA Cancer J Clin 2018;68:116-132. https://doi.org/10.3322/caac.21438.

  10. Ministerio de Salud y Protección Social, Colciencias,Instituto Nacional de CancerologíaESE. Guía de práctica clínica para la detección,tratamiento y seguimiento de linfoma Hodgkiny no Hodgkin en población mayor de 18 años.Guía No. GPC 2017–35. Colombia: Ministeriode Salud y Protección Social, Colciencias, InstitutoNacional de Cancerología; 2017. Acceso20 de mayo de 2023. Disponible en https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/DE/CA/gpc-linfomas-hodgkinno-hodgkin-poblacion-mayor-18-anos.pdf.

  11. Arévalo-Zambrano M, Molina-Pimienta L,Fernández D. Prevalence and demographiccharacteristics of Hodgkin lymphoma in Colombia,according to the Ministry of Health data.Acta Haematologica Polonica 2021;52:552-557. https://doi.org/10.5603/AHP.2021.0092.

  12. Martínez-Sánchez L, López L, Álvarez-HernándezL, Ruiz C, Villegas-Alzate J, Herrera-Almanza L, et al. Caracterización de pacientescon linfoma de Hodgkin en una institución desalud en Medellín, Colombia. Rev Venez Oncol2022;34:131-140.

  13. Valsami S, Pappa V, Rontogianni D, KontsiotiF, Papageorgiou E, Dervenoulas J, etal. A clinicopathological study of B-cell differentiationmarkers and transcription factorsin classical Hodgkin's lymphoma: a potentialprognostic role of MUM1/IRF4. Haematologica2007;92:1343-1350. https://doi.org/10.3324/haematol.11523.

  14. Liu Y, Sattarzadeh A, Diepstra A, Visser L, vanden Berg A. The microenvironment in classicalHodgkin lymphoma: an actively shaped andessential tumor component. Semin Cancer Biol2014;24:15-22. https://doi.org/10.1016/j.semcancer.2013.07.002.

  15. Liu WR, Shipp MA. Signaling pathways and immuneevasion mechanisms in classical Hodgkinlymphoma. Blood 2017;130:2265-2270. https://doi.org/10.1182/blood-2017-06-781989.

  16. Engert A, Younes A. Hodgkin lymphoma.A comprehensive overview. Cham, Alemania:Springer International Publishing; 2015.https://doi.org/10.1007/978-3-319-12505-3.

  17. Opinto G, Agostinelli C, Ciavarella S, GuariniA, Maiorano E, Ingravallo G. Hodgkinlymphoma: A special microenvironment. J ClinMed 2021;10:4665. https://doi.org/10.3390/jcm10204665.

  18. Jona A, Szodoray P, Illés A. Immunologicpathomechanism of Hodgkin's lymphoma.Exp Hematol 2013;41:995-1004. https://doi.org/10.1016/j.exphem.2013.09.014.

  19. Hjalgrim H, Askling J, Rostgaard K, Hamilton-Dutoit S, Frisch M, Zhang JS, et al.Characteristics of Hodgkin's lymphoma afterinfectious mononucleosis. N Engl J Med

  20. 2003;349:1324-1332. https://doi.org/10.1056/NEJMoa023141.20. Reichel JB, McCormick J, Fromm JR, ElementoO, Cesarman E, Roshal M. Flowsortingand exome sequencing of theReed-Sternberg cells of classical Hodgkin lymphoma.J Vis Exp 2017;124:54399. https://doi.org/10.3791/54399.

  21. Satou A, Takahara T, Nakamura S. An updateon the pathology and molecular featuresof Hodgkin lymphoma. Cancers (Basel)2022;14:2647. https://doi.org/10.3390/cancers14112647.

  22. Hoffman R, Benz EJ, Silberstein LE, HeslopHE, Weitz JI, Salama ME. Hematology basic.Principles and practice. Philadelphia: Elsevier;2022. ISBN: 9780323733892.

  23. Küppers R. The biology of Hodgkin's lymphoma.Nat Rev Cancer 2009;9:15-27. https://doi.org/10.1038/nrc2542.

  24. Fend F, Quintanilla-Martinez L. Hodgkin lymphoma.In: Hsi ED, ed. Hematopathology. 3rded. Philadelphia, PA: Elsevier; 2018. p. 363–393.

  25. Hudnall SD, Much MA, Siddon AJ. Pathologyof Hodgkin lymphoma. Pocket Guideto Diagnostic Hematopathology. Cham, Alemania:Springer; 2018. p. 13–34. https://doi.org/10.1007/978-3-030-10630-0_12.

  26. Pérez-Zúñiga JM, Aguilar-Andrade C, Álvarez-Vera JL. Linfoma de Hodgkin. Rev HematolMex 2019;20:124-130.

  27. Connors JM, Cozen W, Steidl C, Carbone A,Hoppe RT, Flechtner HH, et al. Hodgkin lymphoma.Nat Rev Dis Primers 2020;6:61. https://doi.org/10.1038/s41572-020-0189-6.

  28. Ansell SM. Hodgkin lymphoma: A 2020 updateon diagnosis, risk-stratification, and management.Am J Hematol 2020;95:978-989. https://doi.org/10.1002/ajh.25856.

  29. Fratoni S, Niscola P. The uncommon faces ofclassic Hodgkin lymphoma. Hematopathology2019;4:9–23.

  30. Tousseyn TA, King RL, Fend F, Feldman AL,Brousset P, Jaffe ES. Evolution in the definitionand diagnosis of the Hodgkin lymphomas andrelated entities. Virchows Arch 2023;482:207-226. https://doi.org/10.1007/s00428-022-03427-z.

  31. Borchmann P, Goergen H, Kobe C, Lohri A,Greil R, Eichenauer DA, et al. PET-guidedtreatment in patients with advanced-stageHodgkin's lymphoma (HD18): final results ofan open-label, international, randomised phase3 trial by the German Hodgkin Study Group.Lancet 2017;390:2790-2802. https://doi.org/10.1016/s0140-6736(17)32134-7.

  32. Gattringer G, Greil R, Radaszkiewicz T, HuberH. In situ quantification of T-cell subsets,NK-like cells and macrophages in Hodgkin'sdisease: quantity and quality of infiltration densitydepends on histopathological subtypes.Blut 1986;53:49-58. https://doi.org/10.1007/bf00320582.

  33. Mani H, Jaffe ES. Hodgkin lymphoma: an updateon its biology with new insights into classification.Clin Lymphoma Myeloma 2009;9:206-216. https://doi.org/10.3816/CLM.2009.n.042.

  34. Piris MA, Medeiros LJ, Chang KC. Hodgkinlymphoma: a review of pathological featuresand recent advances in pathogenesis. Pathology2020;52:154-165. https://doi.org/10.1016/j.pathol.2019.09.005.

  35. Wang W, Zhang Q, Medeiros LJ. Syncytialvariant of nodular sclerosis Hodgkin lymphoma:an under-emphasized variant. Hum Pathol2021;117:115-125. https://doi.org/10.1016/j.humpath.2021.05.008.

  36. Al-Antary E, Jesudas R, George A, PoulikJ, Savaşan S. Syncytial variant nodularsclerosis classical Hodgkin lymphoma inan adolescent and review of the literature:A unique entity. J Pediatr Hematol Oncol2019;41:e167-e170. https://doi.org/10.1097/mph.0000000000001245.

  37. Hartmann S, Jakobus C, Rengstl B, Döring C,Newrzela S, Brodt HR, et al. Spindle-shapedCD163+ rosetting macrophages replace CD4+T-cells in HIV-related classical Hodgkin lymphoma.Mod Pathol 2013;26:648-657. https://doi.org/10.1038/modpathol.2012.217.

  38. Thompson LD, Fisher SI, Chu WS, NelsonA, Abbondanzo SL. HIV-associated Hodgkinlymphoma: a clinicopathologic and immunophenotypicstudy of 45 cases. Am J Clin Pathol2004;121:727-738. https://doi.org/10.1309/pnvq-0pqg-xhvy-6l7g.

  39. Mohr CF, Kalmer M, Gross C, Mann MC, SterzKR, Kieser A, et al. The tumor marker Fascinis induced by the Epstein-Barr virus-encodedoncoprotein LMP1 via NF-κB in lymphocytesand contributes to their invasive migration.Cell Commun Signal 2014;12:46. https://doi.org/10.1186/s12964-014-0046-x.

  40. Tzankov A, Zimpfer A, Pehrs AC, Lugli A,Went P, Maurer R, et al. Expression of Bcellmarkers in classical hodgkin lymphoma:a tissue microarray analysis of 330 cases.Mod Pathol 2003;16:1141-1147. https://doi.org/10.1097/01.Mp.0000093627.51090.3f.

  41. Moore EM, Swerdlow SH, Gibson SE. J chainand myocyte enhancer factor 2B are useful in differentiatingclassical Hodgkin lymphoma fromnodular lymphocyte predominant Hodgkinlymphoma and primary mediastinal large B-celllymphoma. Hum Pathol 2017;68:47-53. https://doi.org/10.1016/j.humpath.2017.08.015.

  42. Slack GW, Ferry JA, Hasserjian RP, SohaniAR, Longtine JA, Harris NL, et al. Lymphocytedepleted Hodgkin lymphoma: an evaluationwith immunophenotyping and genetic analysis.Leuk Lymphoma 2009;50:937-943. https://doi.org/10.1080/10428190902930488.

  43. Kezlarian B, Alhyari M, Venkataraman G, KarnerK, Inamdar KV, Menon MP. GATA3 immunohistochemicalstaining in Hodgkin lymphoma:diagnostic utility in differentiating classicHodgkin lymphoma from nodular lymphocytepredominant Hodgkin lymphoma and othermimicking entities. Appl ImmunohistochemMol Morphol 2019;27:180-184. https://doi.org/10.1097/pai.0000000000000581.

  44. Van Slambrouck C, Huh J, Suh C, Song JY,Menon MP, Sohani AR, et al. Diagnostic utilityof STAT6 (YE361) expression in classical Hodgkinlymphoma and related entities. Mod Pathol2020;33:834-845. https://doi.org/10.1038/s41379-019-0428-0.

  45. Asano N, Oshiro A, Matsuo K, Kagami Y, IshidaF, Suzuki R, et al. Prognostic significance ofT-cell or cytotoxic molecules phenotype in classicalHodgkin's lymphoma: a clinicopathologicstudy. J Clin Oncol 2006;24:4626-4633. https://doi.org/10.1200/jco.2006.06.5342.

  46. Klein JL, Nguyen TT, Bien-Willner GA, ChenL, Foyil KV, Bartlett NL, et al. CD163 immunohistochemistryis superior to CD68 in predictingoutcome in classical Hodgkin lymphoma.Am J Clin Pathol 2014;141:381-387. https://doi.org/10.1309/ajcp61tlmxlsljys.

  47. Campo E, Jaffe ES, Cook JR, Quintanilla-Martinez L, Swerdlow SH, Anderson KC,et al. The International Consensus Classificationof Mature Lymphoid Neoplasms: a reportfrom the Clinical Advisory Committee. Blood2022;140:1229-1253. https://doi.org/10.1182/blood.2022015851.

  48. Wu D, Thomas A, Fromm JR. Reactive T cellsby flow cytometry distinguish Hodgkin lymphomasfrom T cell/histiocyte-rich large B cell lymphoma.Cytometry B Clin Cytom 2016;90:424-432. https://doi.org/10.1002/cyto.b.21261.

  49. Spina V, Bruscaggin A, Cuccaro A, MartiniM, Di Trani M, Forestieri G, et al. Circulatingtumor DNA reveals genetics, clonal evolution,and residual disease in classical Hodgkin lymphoma.Blood 2018;131:2413-2425. https://doi.org/10.1182/blood-2017-11-812073.

  50. Straus DJ, Jung SH, Pitcher B, KostakogluL, Grecula JC, Hsi ED, et al. CALGB 50604:risk-adapted treatment of nonbulky earlystageHodgkin lymphoma based on interimPET. Blood 2018;132:1013-1021. https://doi.org/10.1182/blood-2018-01-827246.

  51. Sasse S, Bröckelmann PJ, Goergen H, PlütschowA, Müller H, Kreissl S, et al. Long-termfollow-up of contemporary treatment in earlystageHodgkin lymphoma: updated analysesof the German Hodgkin Study Group HD7,HD8, HD10, and HD11 trials. J Clin Oncol2017;35:1999-2007. https://doi.org/10.1200/jco.2016.70.9410.

  52. Stephens DM, Li H, Schöder H, StrausDJ, Moskowitz CH, LeBlanc M, et al. Five-year follow-up of SWOG S0816: limitationsand values of a PET-adapted approachwith stage III/IV Hodgkin lymphoma. Blood2019;134:1238-1246. https://doi.org/10.1182/blood.2019000719.

  53. Casasnovas RO, Bouabdallah R, Brice P, LazaroviciJ, Ghesquieres H, Stamatoullas A, etal. PET-adapted treatment for newly diagnosedadvanced Hodgkin lymphoma (AHL2011): arandomised, multicentre, non-inferiority, phase3 study. Lancet Oncol 2019;20:202-215. https://doi.org/10.1016/s1470-2045(18)30784-8.

  54. Evens AM, Hong F, Gordon LI, Fisher RI, BartlettNL, Connors JM, et al. The efficacy and tolerabilityof adriamycin, bleomycin, vinblastine,dacarbazine and Stanford V in older Hodgkinlymphoma patients: a comprehensive analysisfrom the North American intergroup trialE2496. Br J Haematol 2013;161:76-86. https://doi.org/10.1111/bjh.12222.

  55. Evens AM, Antillón M, Aschebrook-KilfoyB, Chiu BC. Racial disparities in Hodgkin'slymphoma: a comprehensive population-basedanalysis. Ann Oncol 2012;23:2128-2137.https://doi.org/10.1093/annonc/mdr578.

  56. Comisión Económica para América Latina yel Caribe (CEPAL)/Fondo de Población de lasNaciones Unidas (UNFPA). Afrodescendientesy la matriz de la desigualdad social en AméricaLatina: Retos para la inclusión. NacionesUnidas, Santiago: Documentos de Proyectos;2020.

  57. Brice P, de Kerviler E, Friedberg JW. ClassicalHodgkin lymphoma. Lancet 2021;398:1518-1527.https://doi.org/10.1016/s0140-6736(20)32207-8.




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