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    Hodgkin's Lymphoma

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    Wilson Tiang Ko-Ping
    Hodgkin's lymphoma is a malignancy of the lymphatic system that is characterized by the presence of Reed-Sternberg cells. It has unknown causes but is associated with Epstein-Barr virus. Symptoms include painless swelling of lymph nodes in the neck, chest, or abdomen. Staging involves the Ann Arbor system and helps determine prognosis and treatment, which typically involves chemotherapy and radiation therapy. With treatment, the 5-year survival rate is excellent at around 90%.

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    Hodgkin's Lymphoma

    Uploaded by

    Wilson Tiang Ko-Ping
    282 views18 pages
    Hodgkin's lymphoma is a malignancy of the lymphatic system that is characterized by the presence of Reed-Sternberg cells. It has unknown causes but is associated with Epstein-Barr virus. Symptoms include painless swelling of lymph nodes in the neck, chest, or abdomen. Staging involves the Ann Arbor system and helps determine prognosis and treatment, which typically involves chemotherapy and radiation therapy. With treatment, the 5-year survival rate is excellent at around 90%.

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    Brief notes on HL

    Original Title

    Hodgkin’s Lymphoma

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    Hodgkin's lymphoma is a malignancy of the lymphatic system that is characterized by the presence of Reed-Sternberg cells. It has unknown causes but is associated with Epstein-Barr virus. Symptoms include painless swelling of lymph nodes in the neck, chest, or abdomen. Staging involves the Ann Arbor system and helps determine prognosis and treatment, which typically involves chemotherapy and radiation therapy. With treatment, the 5-year survival rate is excellent at around 90%.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    282 views18 pages

    Hodgkin's Lymphoma

    Uploaded by

    Wilson Tiang Ko-Ping
    Hodgkin's lymphoma is a malignancy of the lymphatic system that is characterized by the presence of Reed-Sternberg cells. It has unknown causes but is associated with Epstein-Barr virus. Symptoms include painless swelling of lymph nodes in the neck, chest, or abdomen. Staging involves the Ann Arbor system and helps determine prognosis and treatment, which typically involves chemotherapy and radiation therapy. With treatment, the 5-year survival rate is excellent at around 90%.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 18

    Hodgkins Lymphoma

    Formally known as Hodgkins Disease


    Unique neoplasm in which the malignant cell,
    the Reed-Stenberg cell (RSC), represents only
    a small proportion of cells constituting the bulk
    of the tumor.

    Hodgkins Lymphoma
    Malignancy of lymphoid tissue
    Unknown aetiology
    Highly associated with Epstein-Barr Virus
    Boys > Girls
    Bimodal distribution
    Peaks : 1) Adolescent/ young adult years
    (Rare below 5 years of age)
    2) After 50 years old

    Pathophysiology

    HL-RSC carry clonal immunoglobulin gene rearrangements,


    which establishes their clonality and their B cell origin.
    Germinal-center B-cells undergo clonal expansion and
    activate the process of somatic hypermutation that
    introduces mutations at a high rate into rearranged
    immunoglobulin variable genes.
    Germinal-center B-cells with unfavorable mutations are
    functionally crippled and undergo programmed cell death
    (apoptosis).
    The reason for the apoptosis resistance of HL-RSC
    precursors is unclear but may involve several distinct
    transforming events, such as Epstein-Barr Virus (EBV)
    infection.

    Clinical manifestations
    Painless ,firm lymphadenopathy
    Confined to one or two lymph nodes areas
    (supraclavicular and cervical lymph nodes
    Mediastinal lymphadenopathy cough, shortness
    of breadth, chest pain RISK of respiratory failure
    May also cause superior vena cava syndrome
    (dyspnoea, facial swelling, head fullness,cough,
    arm swelling,chest pain, dysphagia, orthopnea,
    distorted vision, hoarseness, stridor,headache,
    nasal stuffiness, nausea, pleural effusions, and
    light-headedness.)

    Ann Arbor Staging system


    Stage I - Single lymph node
    region or single extranodal site
    Stage II - Two or more lymph
    node regions on the same side
    of the diaphragm
    Stage III - Lymph node regions
    on both sides of the diaphragm
    Stage IV - Diffuse or
    disseminated involvement of
    one or more extralymphatic
    organs (liver, bone marrow,
    lung) or tissues with or without
    associated lymph node
    involvement (The spleen is
    considered a nodal site.)

    A or B designations are also used. B


    includes the presence of at least one
    of the following symptoms:
    1) Fever > 38 degree Celcius for 3
    consecutive days
    2) Drenching night sweats
    3) Unintentional weight loss of 10% or more
    within 6 months of diagnosis

    Lab/ Imaging studies


    Complete blood count (CBC)
    1. Hemolytic anemia (Coombs positive), anemia of
    chronic disease, or anemia secondary to involvement of
    the bone marrow
    2. Leukocytosis, lymphopenia, eosinophilia, monocytosis
    3. Thrombocytopenia due to marrow infiltration or
    idiopathic thrombocytopenia purpura
    Esr, C-reactive protein, serum ferritin and copper:
    Increased
    Calcium, alkaline phosphatase (bony metastasis),
    lactate dehydrogenase, uric acid

    Chest X-ray: access mediastinal mass


    CT scan: abdominal involvement
    Lymph node Biopsy

    Pathologic
    confirmation: ReedSternberg cells

    Binucleated or
    multinucleated
    giant cells. Bilobed
    nucleus with 2 large
    nucleoli that
    produces the
    characteristic "owls
    eye" appearance.
    The typical RSC is
    characterized by
    CD30 positivity,
    absence of J chains

    Histopathology subtypes:

    1)
    2)
    3)
    4)

    Lymphocyte predominant: 10-15%


    Nodular sclerosis : 50-60%
    Mixed cellularity : 30%
    Lymphocyte depletion: <5%

    Differential diagnosis

    Leukemia
    Rhabdomysarcoma
    Nasopharyngeal carcinoma
    Germ cell tumour
    Thymomas
    Infectious mononucleosis
    Branchial cleft, thyroglossal duct cysts
    Cat scratch disease
    Toxoplasmosis
    Tinea capitis

    Treatment
    Chemotherapy (highly sensitive)
    - Cyclophosphamide, vincristine,
    procarbazine, doxorubicin,
    bleomycin, vinblastine, prednisone,
    etoposide
    Low dose radiation therapy

    Complication
    From treatment:
    Short term:
    - Immunosuppresion: nausea, vomiting,
    alopecia
    Late adverse effects:
    - Second malignant neoplasm( AML, thyroid
    malignancies, breast cancer)
    - Hypothyroid, impaired soft tissue and bone
    growth, cardiac dysfunction, pulmonary
    fibrosis

    Prognosis
    Excellent
    90% - 5 years overall survival rate
    Survival in developing countries may
    be lower, depending on availability of
    care and medications, distance to
    the treating centers, and number of
    patients who abandon therapy before
    completion.

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