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Hodgkin’s vs Non-Hodgkin’s — MRCP Part 1

TL;DR

For MRCP Part 1, distinguishing Hodgkin’s lymphoma (HL) from non-Hodgkin’s lymphoma (NHL) is a classic, high-yield topic. HL presents with contiguous lymph node spread and Reed–Sternberg cells, whereas NHL is heterogeneous with frequent extranodal involvement. Master the clinical patterns, staging, and key associations (EBV, HIV, H. pylori) to secure easy marks. This guide distils the most tested concepts, pitfalls, and revision essentials.


Why this matters

Lymphoma consistently appears in MRCP Part 1 as clinical scenarios, pathology interpretation, and association-based questions. The exam tests your ability to differentiate patterns rather than recall isolated facts.

This article complements the MRCP Part 1 overview and should be reinforced with active recall using the Free MRCP MCQs.


Core sections

1. Classification overview

Lymphomas are broadly divided into:

  • Hodgkin’s lymphoma (HL)

  • Non-Hodgkin’s lymphoma (NHL)

HL is relatively uniform in pathology and behaviour, whereas NHL comprises a wide spectrum of diseases (B-cell and T-cell, indolent and aggressive).

2. Key differences: Hodgkin’s vs Non-Hodgkin’s

Feature

Hodgkin’s Lymphoma

Non-Hodgkin’s Lymphoma

Age distribution

Bimodal (young adults + elderly)

Increasing with age

Spread

Contiguous

Non-contiguous

Extranodal disease

Rare

Common

Histology

Reed–Sternberg cells

No RS cells

Cell origin

B-cell

B-cell (most), T-cell

EBV association

Strong

Variable

Prognosis

Generally favourable

Variable

👉 Exam pearl: Contiguous lymph node spread is a hallmark of Hodgkin’s lymphoma.

3. The 5 most tested subtopics

a) Reed–Sternberg cells

  • Pathognomonic for HL

  • Binucleate “owl’s eye” nuclei

  • Immunophenotype: CD15+, CD30+

b) B symptoms

  • Fever

  • Night sweats

  • Weight loss (>10% in 6 months)

👉 Essential for staging and prognosis (Ann Arbor system).

c) Extranodal involvement

  • Rare in HL

  • Common in NHL (e.g. GI tract, CNS, skin)

👉 High-yield: Gastric lymphoma → think MALT lymphoma (NHL) linked to Helicobacter pylori.

d) Aetiological associations

  • HL → Epstein–Barr virus (EBV)

  • NHL → HIV, autoimmune diseases, H. pylori

e) Indolent vs aggressive NHL

  • Indolent: follicular lymphoma

  • Aggressive: diffuse large B-cell lymphoma (DLBCL), Burkitt lymphoma

👉 Exam insight: Indolent lymphomas are slow but incurable; aggressive lymphomas are fast but potentially curable.

4. Staging (Ann Arbor system)

  • Stage I: single lymph node region

  • Stage II: same side of diaphragm

  • Stage III: both sides of diaphragm

  • Stage IV: diffuse extranodal involvement

Suffix:

  • A = no systemic symptoms

  • B = systemic symptoms present

5. Investigations

  • Excisional lymph node biopsy (gold standard)

  • PET-CT for staging and response assessment

  • Blood tests: LDH (marker of tumour burden), FBC

👉 Common mistake: Fine needle aspiration alone is inadequate for lymphoma diagnosis.

6. Treatment overview

  • HL: ABVD chemotherapy ± radiotherapy

  • NHL: Treatment depends on subtype (e.g. R-CHOP)

👉 Rituximab targets CD20 on B cells and is widely used in NHL.


High-yield summary list

  1. Reed–Sternberg cells = Hodgkin’s lymphoma

  2. Contiguous spread = Hodgkin’s

  3. Extranodal disease = Non-Hodgkin’s

  4. EBV association stronger in Hodgkin’s

  5. B symptoms influence staging

  6. NHL is more common overall

  7. Indolent NHL is usually incurable

  8. PET-CT is used for staging

  9. LDH correlates with tumour burden

  10. Rituximab targets CD20


Practical examples / mini-cases

Mini-MCQ

A 27-year-old woman presents with painless cervical lymphadenopathy and night sweats. Imaging shows contiguous lymph node involvement. Biopsy reveals large binucleate cells with prominent nucleoli.

Most likely diagnosis? A. Follicular lymphomaB. Diffuse large B-cell lymphomaC. Hodgkin’s lymphomaD. Burkitt lymphoma

Answer: C. Hodgkin’s lymphoma

Explanation:

  • Young age + B symptoms

  • Contiguous lymph node spread

  • Reed–Sternberg cells are diagnostic

MRCP Part 1 haematology revision notes on lymphoma with study materials on desk

Common pitfalls

  • Confusing extranodal disease as typical for Hodgkin’s lymphoma

  • Forgetting NHL heterogeneity

  • Ignoring the role of B symptoms in staging

  • Using FNA instead of excisional biopsy

  • Misunderstanding indolent vs aggressive lymphoma outcomes


Practical study-tip checklist

  • ✔ Memorise HL vs NHL comparison table

  • ✔ Learn Reed–Sternberg immunophenotype (CD15, CD30)

  • ✔ Practise Ann Arbor staging questions

  • ✔ Revise key associations (EBV, HIV, H. pylori)

  • ✔ Attempt timed practice via Start a mock test

  • ✔ Reinforce using spaced repetition and MCQs

👉 Cross-link suggestion: Revise alongside related haematology topics such as anaemias and leukaemias for integrated exam preparation.


FAQs

1. What distinguishes Hodgkin’s from non-Hodgkin’s lymphoma?

Hodgkin’s lymphoma features Reed–Sternberg cells and contiguous spread, while non-Hodgkin’s lymphoma is diverse with frequent extranodal involvement.

2. Are B symptoms specific to Hodgkin’s lymphoma?

No. They occur in both HL and NHL but are particularly emphasised in Hodgkin’s for staging purposes.

3. Why is excisional biopsy necessary in lymphoma?

It preserves lymph node architecture, which is essential for accurate diagnosis and classification.

4. What is the role of PET-CT in lymphoma?

PET-CT is used for staging and monitoring treatment response.

5. Which infections are linked to lymphoma?

EBV is associated with Hodgkin’s lymphoma, while H. pylori is linked to MALT lymphoma and HIV increases NHL risk.


Ready to start?

Consolidate your knowledge with Free MRCP MCQs and assess your readiness with a Start a mock test. For a structured roadmap, revisit the MRCP Part 1 overview.


Sources

 
 
 

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