Hodgkin's Lymphoma Flashcards
Classic cell on biopsy in Hodgkins
Reed-Sternberg cell
large cells that are either multinucleated or have a bi-lobed nucleus with prominent eosinophilic inclusion-like nucleoli
“owls eye appearance”
Bimodal age distribution for Hodgkins
3rd decade (30s)
7th decade (70s)
What are the 4 histological classifications of Hodgkins?
Nodular sclerosing
Mixed cellularity
Lymphocyte predominant
Lymphocyte depleted
Which of the histological subtypes has the best and worst prognosis?
Lymphocyte predominant = BEST
Lymphocyte depleted = WORST
B symptoms indicate a poor prognosis in Hodgkins. Give examples of these
weight loss
fever
night sweats
Other factors which may indicate a poor prognosis in Hodgkins
Male
age > 45
stage 4
Low Hb
Lymphocyte count <8%
What viruses increase the risk f developing Hodgkin’s lymphoma?
HIV
Epstein-Barr virus
Clinical features of Hodgkin’s
Painless, asymmetrical lymphadenopathy
alcohol-induced lymph node pain
‘B symptoms’
Findings on blood tests in Hodgkins
- normocytic anaemia
- eosinophilia
(caused by production of cytokines e.g. IL-5) - raised LDH
Describe Ann Arbor Staging
I: single lymph node
II: 2 or more lymph nodes/regions on the same side of the diaphragm
III: nodes on both sides of the diaphragm
IV: spread beyond lymph nodes
What is the difference between A and B staging in Hodgkins
A - no systemic symptoms
B - presence of B symptoms
Management options in Hodgkins
- chemotherapy
- radiotherapy
- combined modality therapy (CMT)
=> chemotherapy followed by radiotherapy - hematopoietic cell transplantation (for relapse/refractory disease)
Chemotherapy regimens used in Hodgkins
ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine)
BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone)
=> better remission rates but higher toxicity
What secondary malignancies are patients with Hodgkin’s at higher risk of?
solid tumours: breast and lung
