Hodgkin's lymphoma Flashcards
What is Hodgkin’s lymphoma?
Hodgkin’s lymphoma (HL) is an uncommon malignancy arising from mature B cells.
HL is characterised by the presence of Reed-Stenberg cells (Owl’s eye appearance)
Where would you find lymphocytes in the body in the absence of infection?
Lymphocytes are present in the circulation, bone marrow, lymph nodes and other organs that form the reticuloendothelial system such as the liver and spleen.
What are lymphomas?
Lymphomas are malignancies that involve the lymphocytes.
Lymphomas are solid tumours involving the lymph nodes-when there’s the involvement of other organs, it is referred to as extra-nodal involvement.
What are Reed-Stenberg cells?
They are large cells that are either multinucleated cells or have bilobed nuclei.
Aetiology of HL
Remains unclear
Likely to be multi-factorial
EBV linked to HL
Presentation of HL suggests an infectious aetiology
Pathophysiology of HL
HL is a B cell malignancy and immunoglobin expression is typically absent despite gene re-arrangements and somatic hyper-mutation
Classification of HL
Nodular sclerosis (70%)
Mixed cellularity (25%)
Lymphocyte-rich (5%)
Lymphocye-depleted (<1%)
Signs and symptoms
Lymphadenopathy (usually cervical)
B symptoms (in 30% of patients)- fever, night sweats and weight loss
Systemic symptoms- generalised pruritus, alcohol-induced pain
Symptoms from enlarged lymph nodes- SOB, chest pain, abdominal pain. SVC syndrome
Risk factors for HL
Hx of EBV infection
FHx of HL
Young adults from the higher socioeconomic class
Investigations for HL
FBC with differential (low Hb with platelets) Metabolic panel ESR (elevated) CXR (large mediastinal adenopathy) PET-CT scan Excisional lymph node biopsy Contrast CT neck, chest (enlarged lymph nodes) TFTs Bone marrow biopsy
Differentials of HL
NHL
Lymphadenopathy from other malignancies
Infectious mononucleosis
Reactive lymph nodes
Management of HL
RCHOP Rituximab Cyclophosphamide Hydroxyaunrubicin Vincristine (oncovin) Prednisolone
