Hodgkin's Lymphoma

Question 1

Define Hodgkin’s Lymphoma?

Answer 1

Lymphomas are neoplasms of lymphoid cells, originating in the lymph nodes or other lymphoid tissues

Question 2

How is Hodgkin’s Lymphoma diagnosed?

Answer 2

Histopathologically by the presence of Reed-Sternberg Cells (binucleate lymphocytes)

Question 3

What percentage of all lymphomas is Hodgkin’s Lymphoma?

Answer 3

15% of all lymphomas

Question 4

What is the aetiology of Hodgkin’s Lymphoma?

Answer 4

Likely to be an environmental trigger in a genetically susceptible individual
EBV genome has been detected in 50% of Hodgkin’s Lymphoma

Question 5

What is the epidemiology of Hodgkin’s Lymphoma?

Answer 5

Bimodal age distribution with peaks at 20-30 yrs and > 50 yrs
More common in Males

Question 6

What are the presenting symptoms of Hodgkin’s Lymphoma?

Answer 6

Painless Enlarging Mass
B symptoms of Lymphoma
Other Symptoms

Question 7

What are some of the other features of the mass in Hodgkin’s Lymphoma?

Answer 7

Most commonly in the neck
Can also be in the axilla or the groin
The mass may become painful after alcohol ingestion

Question 8

What are the B symptoms of Lymphoma in Hodgkin’s Lymphoma?

Answer 8

Fever > 38 degrees
Night Sweats
Weight loss > 10% body weight in the past 6 months

Question 9

What is it called if the fever is cyclical?

Answer 9

Pel-Ebstein Fever

Question 10

What are the other symptoms in Hodgkin’s Lymphoma?

Answer 10

Pruritis
Cough
Dyspnoea

Question 11

What are the signs of Hodgkin’s Lymphoma on physical examination?

Answer 11

Non-tender firm rubbery lymphadenopathy (may be cervical, axillary or inguinal)
Splenomegaly (or sometimes, hepatosplenomegaly)
Skin excoriations
Signs of intrathoracic disease (e.g. pleural effusion, superior vena cava obstruction)

Question 12

What investigations would you do for Hodgkin’s Lymphoma?

Answer 12

Bloods 
Lymph Node Biopsy 
Bone Marrow Aspirate and Trephine Biopsy
Imaging 
Ann Arbor Staging

Question 13

What bloods would you do for Hodgkin’s Lymphoma and what might you see?

Answer 13

FBC:

• Anaemia of Chronic Disease
• Leucocytosis
• High Neutrophils
• High Eosinophils
• Lymphopaenia in advanced disease

High ESR and CRP

Question 14

What imaging would you do in Hodgkin’s Lymphoma?

Answer 14

CXT
CT
PET

Question 15

What is Ann Arbor Staging?

Answer 15

I = Single Lymph node region
II = 2+ lymph node regions on one side of the diaphragm 
III =  lymph node regions on both sides of the diaphragm 
IV =  extranodal involvement 
A = absence of B symptoms 
B = presence of B symptoms 
E = localised extranodal extension
S = involvement of spleen