Chapter 24: Disorders of White Blood Cells and Lymphoid Tissues

Hodgkin lymphoma is distinguished by the presence of Reed-Sternberg cells, which display characteristic morphologic features including paired mirror-image nuclei and prominent eosinophilic nucleoli that serve as diagnostic hallmarks of the disease. The etiology of both Hodgkin lymphoma and non-Hodgkin lymphoma remains incompletely understood, though epidemiologic and molecular evidence suggests contributions from environmental exposures and genetic predisposition. Most lymphoid malignancies originate within lymph nodes, and non-Hodgkin lymphomas demonstrate a predominant B-cell derivation in approximately 80 to 85 percent of cases, reflecting the abundance of B lymphocytes in normal lymphoid tissue. Therapeutic approaches for B-cell non-Hodgkin lymphomas frequently incorporate monoclonal antibody technology designed to selectively target surface antigens on malignant B cells, improving treatment specificity and reducing systemic toxicity compared to conventional chemotherapy alone. Acute lymphocytic leukemia represents an aggressive hematologic malignancy requiring intensive combination chemotherapy regimens to achieve complete remission and long-term survival. A critical component of acute lymphocytic leukemia management involves prophylactic intrathecal chemotherapy delivered via lumbar puncture, which addresses the propensity of leukemic blasts to infiltrate the central nervous system and cause leukostasis and meningeal involvement that would otherwise significantly worsen prognosis and complicate disease management.