1. Leukemia case #9 Hello lovely girl وداد ابو رمضان حليمة نوفل
سهير الدردساوي
Hello lovely girl

2. A 30 years old man , the patient reported history of drenching night sweats , low grade fever , pruritic rash on the body , and almost 15% weight loss during the previous 3 month . Also he found an enlarging mass in his lymph nod in the neck during the latest month , he have bone pain ,weakness ,chest pain ,abdominal pain ,shortness of breath ,cough ,bowl distribution ,Physical examination suggested the compression of sciatic nerve.

3. NORMAL RANGE
RESALT
TEST NAME
( )*10^9 /L
L/ *10^9
WBC count
( )*10^9 /L
3.3*10^9 /L
RBC count
( )*10^9 /L
491*10^9 /L
PIT count
13-16 g/dl
10 g/dl
Hbg
(40-75)%
84.3%
Neutrophil rate
(20-50)%
11.2%
Lymphocyte rate
(1-3)% 5%
Eosinophil rate

4. The doctor take biopsy from the lymph nod
enlargement in the neck and saw the RS cell (Reed Sternberg) which the large cell with 2 or more large oval nuclei and huge nucleolus , which is separated from the thickened nuclear membrane by clear zone.
And make flow cytometer to determined the marker in the cell we show CD25 ,CD15 ,CD30 ,IL-2 receptor it is the marked for RS cell .

5. BLOOD SMEAR
BIOPSY

6. Hodgkin's Disease
lymphoma

7. Hodgkin's Disease
Hodgkin's disease (HD) is a neoplastic disorder with development of specific infiltrate containing pathologic Reed- Sternberg cells. It usually arises in lymph nodes and spreads to contiguous groups. Extranodal presentation are rare. Disease is associated with defective cellular immunity.

8. Incidence 2-4 cases per 100000 population / year
bimodal age distribution :
15-35 years and above 50 years
male predominance M:F = 1,7:1

9. Clinical Presentation
Nontender lymph nodes enlargement ( localised )
neck and supraclavicular area %
mediastinal adenopathy 50%
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

10. Classification -Lymphocyte predominant HD (LPHD)
-Nodular sclerosing HD (NSHD)
-Mixed cellularity HD (MCHD)
-Lymphocyte depleted HD (LDHD)

11. Immunophenotyping
The consistent antigenic markers on RS cells include:
CD25, the IL-2 receptor, CD15 and CD30.
The NSHD and MCHD are more commonly associated with B lymphoid markers while LPHD is associated with T lymphoid markers.

12. Staging of Hodgkin's Disease

13. Treatment
According to the stage of disease, early stage requires localized radiotherapy to the involved lymph nodes, while advanced stage involve the use of combination chemotherapy with or without radiotherapy.

14. Prognosis
With modern treatment, more than 80% of cases of stage I HD and more than 50% of stage IV HD survive for more than 10 years after presentation. Most of these can be considered to be cured.