Edward Camacho Mina 1061 MD4 WINDSOR UNIVERSITY HODGKIN LYMPHOMA

Lymphoma  Clonal malignant disorders that are derived from lymphoid cells: either precursor or mature T-cell or B-cell  Majority are of B- cell origin

Hodgkin lymphoma  It is a neoplastic disorder and proliferation of Reed-Sternberg (RS) cells, which are large B cells with multilobed nuclei and prominent nucleoli ('owl-eyed nuclei.classically  It usually arises in lymph nodes and spreads to contiguous groups. Extranodal presentation are rare. Disease is associated with defective cellular immunity.

Hodgkin Disease  Incidence:  2-4 cases per population / year  Bimodal age distribution : years and above 50 years  male predominance M:F = 1,7:1

Etiology  most Hodgkin's lymphoma occurs when an infection-fighting cell called a B cell develops a mutation in its DNA.  Infection with EBV

Hodgkin's lymphoma  It is divided into two groups: 1. Classical Hodgkin's lymphoma 2. Lymphocyte-predominant

Classical Hodgkin's lymphoma  This is the most common type of this disease. And patients diagnosed with classical Hodgkin's lymphoma have large and abnormal cells called Reed-Sternberg cells in the lymph nodes.

classical Hodgkin's lymphoma Subtypes of include:  Nodular sclerosis Hodgkin's lymphoma (70% of all cases).  Mixed cellularity Hodgkin's lymphoma  Lymphocyte-depleted Hodgkin's lymphoma  Lymphocyte-rich classical Hodgkin's lymphoma

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Lymphocyte-predominant Hodgkin's lymphoma  This is a rarer type of Hodgkin's lymphoma. In this type of lymphoma, there are very few Reed- Sternberg cells. But there are other abnormal, and large cells with the appearance of popcorn cells.  This lymphoma has better prognosis if diagnosed at an early stage.

Popcorn cells

Risk factors  age. Hodgkin's lymphoma is most often diagnosed in people between the ages of 15 and 35, as well as those older than 55.  A family history of lymphoma. patients with a relative presenting Hodgkin's lymphoma or non-Hodgkin's lymphoma have an increased risk of developing Hodgkin's lymphoma.

Risk factors  sex. Males are more likely to develop Hodgkin's lymphoma than women.  Epstein-Barr infection. People who have had exposure to Epstein-Barr virus, which causes infectious mononucleosis, are more likely to develop Hodgkin's lymphoma.

Clinical Presentation  Nontender lymph nodes enlargement ( localised )  neck and supraclavicular area60-80%  mediastinal adenopathy50%  other ( abdominal, extranodal disease )  systemic symptoms (B symptoms)30%  fever  night sweats  unexplained weight loss (10% per 6 months)  other symptoms  fatigue, weakness, pruritus  cough, chest pain, shortness of breath, vena cava syndrome  abdominal pain, bowel disturbances, ascites  bone pain

Diagnosis of Hodgkin's lymphoma  It is based on microscopic examination of lymph node or other involved tissue  it requires identification of diagnostic Reed-Sternberg cells

REED-STERNBERG ( RS ) Cell

Hodgkin's lymphoma

Diagnosis of Hodgkin's lymphoma  Physical exam. swollen lymph neckunderarm groin swollen spleen liver Checking for swollen lymph nodes, including in the neck, underarm and groin, as well as a swollen spleen or liver.  Blood tests. A sample of your blood is examined in a lab to see if anything in the blood indicates the possibility of cancer.

Diagnosis of Hodgkin's lymphoma  Imaging tests. Imaging tests used to diagnose Hodgkin's lymphoma include X-rays, computerized tomography (CT) scan, magnetic resonance imaging (MRI) and positron emission tomography (PET).

Lymphangiography

Staging  Stage I : Involvement of single LN region  Stage II : Two or more LN regions involved on the same side of diaphragm  Stage III : Involvement of lymph node regions on both sides of diaphragm.  Stage IV : Involvement outside LN areas (Liver, bone marrow)

Treatment  RT  Chemo  Antibody treatment: Rituximab target CD-20  Supportive

Treatment - Guidelines  Indications for RT:  Stage I disease  Stage II disease with 3 or lesser areas involved  Indications for CT  Stage II disease with >3 areas involved  Stage III and IV disease

Mr. Smith, a 25 year old man, presented with malaise, night sweats, weight loss and intermittent fever dating for 3 months. On examination, he had bilateral, cervical and axillary lymphadenopathy. His liver and spleen were not enlarged. Investigation showed that his hemoglobin was low (113g/l) and the white-cell count was normal (4.2 x 109/l. The blood film did not show any abnormal cells. A cervical lymph node was removed for histology. The gross architecture of the node was destroyed; the tissue consisted of histiocytes, eosinophils, lymphocytes and giant binucleate cells known as Reed-Sternberg cells. A bone marrow examination was normal and a tomography showed no involvement of other lymph nodes.