Hodgkin disease is different from other lymphomas. In most lymphomas, cancer cells make up most of a tumor. In Hodgkin disease, the cancer cells (usually special cells called Reed-Sternberg cells) only make up a small part of the cells in a cancerous lymph node. The rest of the cells are normal immune cells.
Scientists now conclude that Hodgkin disease is not a single disease with different types. Rather, Hodgkin disease represents a group of at least two diseases. The two primary classifications of HD are: classic Hodgkin disease and nodular lymphocyte-predominant Hodgkin disease.
Each type of Hodgkin disease tumor grows in slightly different ways:
Nodular sclerosis (NS). Nodular sclerosis accounts for 60 to 80 percent of all Hodgkin disease cases. It almost always appears in people between ages 15 and 35, and is much more common in women than in men. Most people with NS don't have any initial symptoms. When the disease is found, it is usually at stage I or II.
Lymphocyte rich (LR) or lymphoid proliferative (LP). LP Hodgkin disease is usually found in people in their 30s and 40s. It accounts for about 5 percent of all cases. More men than women get LP Hodgkin disease, and the cure rate is very high. B symptoms (fever, night sweats, and weight loss) are very uncommon in LP Hodgkin.
Mixed-cellularity (MC). Mixed-cellularity Hodgkin can be found in all age groups, but is most common in older adults. It is more common in men, and most people aren't diagnosed until the disease is in stage III or IV. B symptoms are very common and often help the doctor diagnose the disease.
Lymphocyte depleted (LD). Lymphocyte depleted Hodgkin disease is the most aggressive Hodgkin disease. This subtype is very rare, accounting for only about 1 percent of Hodgkin disease cases. More Reed-Sternberg cells are present in the lymph nodes of someone with LD Hodgkin disease than in any other type. LD Hodgkin disease is more common in older men. Most people with this form of Hodgkin disease are diagnosed at an advanced stage.
Nodular lymphocyte-predominant Hodgkin disease (NLPHD). This type makes up about 5 percent of all Hodgkin disease cases. It is more common in men than in women, and it usually affects young adults. Most patients are diagnosed at an early stage, and a majority respond to therapy with a complete response. Classic Reed-Sternberg cells are not seen or are very uncommon in patients' tissue samples. Instead, large, circular meshworks of cells take over the lymph nodes, along with large cells called popcorn cells. Late relapses are common, but they usually do not affect survival. The survival rate is favorable even among patients with recurrent disease.