Flashcards in Chapter 16: Hodgkin's lymphoma Deck (25):
What are lymphomas?
Lymphomas are malignancies of lymphocytes that usually accumulate in lymph nodes causing lymphadenopathies.
What differentiates Hodgkin's from Non-Hodgkin's lymphomas?
Hodgkin's lymphomas exhibit Reed-Sternberg cells.
What is the pathogenesis of Hodgkin's lymphomas?
Hodgkin's lymphoma is caused by the malignant transformation of B-lymphoid cells. The characteristic RS cells seen typically posses crippled Ig genes.
What virus is associated with Hodgkin's lymphoma?
EBV is associated with Hodgkin's lymphoma although no causal relationship has been established.
What clinical feature is most commonly associated with Hodgkin's lymphoma?
Painless, non-tender, asymmetrical enlargements of superficial lymph nodes.
What constitutional symptoms are seen in Hodgkin's lymphoma?
(3) alcohol induced pain
(4) weight loss
What hematologic abnormalities are seen in Hodgkins' lymphoma?
HL eventually progresses to pancytopenia
(1) normocytic, normochromic anemia
(3) Lymphopenia (in advanced disease)
(4) Thrombocytopenia (in advanced stages)
How is HL diagnosed?
HL is diagnosed by histologic examination with the findings of multinucleate polyploid RS cells.
What is the immunophenotype of mononuclear Hodgkin's cells?
CD30+, CD15+, and B-cell antigen negative.
What are the 5 types of HL?
(1) Nodular sclerosing
(2) Mixed cellularity
(3) Lymphocyte depleted
(4) Lymphocyte rich
(5) Nodular lymphocyte predominant
What are the distinguishing characteristics of Nodular sclerosis HL?
(1) Collagen bands from the node capsule surround the abnormal tissue.
(2) Lacunar RS cells.
(3) Frequent eosinophilia
What are the distinguishing characteristics of Mixed cellularity HL?
Numerous RS cells with intermediate numbers of lymphocytes.
What are the distinguishing characteristics of Lymphocyte depleted HL?
(1) Usually numerous RS cells
(2) sparse lymphocytes
(3) Lymph node fibrosis
What are the distinguishing characteristics of Lymphocyte rich HL?
(1) Scanty RS cells
(2) many small lymphocytes
(3) both nodular and diffuse
What are the distinguishing characteristics of Nodular lymphocyte predominant HL?
(1) absent RS cells
(2) abnormal polymorphic B cells.
How is clinical staging of HL achieved?
(1) clinical examination
(2) imaging (CT, XR, MRI, PET)
(3) possibly trephine biopsy or liver biopsy as needed.
What do the classifications A and B mean in relation to the staging of HL?
They distinguish whether or not constitutional symptoms are present.
How is HL treated?
Radiotherapy, chemotherapy, or a combination of both.
What is the staging system for HL?
(1) stage 1 (single lesion on 1 side of diaphragm)
(2) Stage II (multiple lesions on one side.)
(3) Stage III (single lesion on each side)
(4) stage IV (multiple lesions on each side)
When is radiotherapy most useful for treating HL?
Radiotherapy is 80% effective in treating patients with type I or II HL.
When is chemotherapy most used to treat HL?
chemotherapy is used most frequently in stage III or IV HL.
What is the most commonly used chemotherapy for HL?
ABVD (adriamycin, bleomycin, vinblastine, and dacarbazine.
What treatment is used if a patient relapses?
Alternative chemotherapy with or without radiotherapy and possible stem cell transplant.
What is the prognosis for HL?
5 year survival rates range from 50-90% based on age, stage and histology.
10 year survival is 80%