Lymphocyte depletion (LD) This is the least common variant and is usually discovered in an advanced stage. Two forms have been described. One has abundant scar-like tissue (fibrosis) with sparse lymphocytes and Reed-Sternberg cells . The other has sheets of malignant cells of different sizes and shapes. It is important to distinguish this sub-type from non-Hodgkin's lymphoma.
How It Spreads One of the unique features of Hodgkin's disease is its pattern of spread. As a rule, HD progresses in an orderly fashion from one lymph node group to the next group on the same side (ipsilateral) or the opposite side (contralateral). Non-Hodgkin's lymphomas, by contrast, are often widespread at diagnosis.
The most characteristic pattern of HD spread is extension of the disease from the lymph nodes in the neck (cervical) to the nodes above the collarbones (supraclavicular), then to the nodes under the arms (axillary) and within the chest (mediastinal and hilar). Although there are different patterns, it is unusual to find areas that have been "skipped," meaning that no apparent disease is found at a site where it would be expected by the rule of orderly progression .
Hodgkin's disease often involves the spleen and may spread to the lungs, liver, bone and bone marrow . Involvement of other parts of the body is rare.
