Hodgkin’s lymphoma

Hodgkin’s lymphoma

• 1.
  HODGKIN’S LYMPHOMA DR. SIDDHARTH
• 2.
  INTRODUCTION  Characterized bythe presence of tumor giant cell “ Reed-Sternberg cell”.  It is classified into five subtypes: 1. Nodular Sclerosis 2. Mixed Cellularity 3. Lymphocyte Rich 4. Lymphocyte Depleted 5. Lymphocyte Predominance
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  “Reed-Sternberg cell”
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  DIFFERENCE HODGKIN’ LYMPHOMA NONHODGKIN’S LYMPHOMA MORE OFTEN LOCALISED IN SINGLE AXIAL GROUP OF LYMPHNODES MORE FREQUENT INVOLVEMENT OF PERIPHERAL NODES ORDERLY SPREAD BY CONTIGUITY NON CONTIGUOUS SPREAD MESENTRIC LYMPHNODES AND WALDAYER RING RARELY INVOLVED COMMONLY INVOLVED EXTRA NODAL INVOLVEMENT UNCOMMON EXTRA NODAL INVOLVEMENT COMMON
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  SPREAD
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  CLINICAL FEATURES  PAINLESSENLARGEMENT OF LYMPHNODES IS THE COMMON PRESENTING SYMPTOM.  Can be associated with fever (Pel Ebstein Fever) and night sweats in disseminated disease.  Wt loss > 10 % of body wt.  A strange paraneoplastic syndrome in HL is pain in the affected lymphnodes on consumption of alcohol.
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  UNUSUAL MANIFESTATIONS  Severeand unexplained itching  Cutaneous disorders such as erythema nodosum and icthyosis form atrophy.  Nephrotic syndrome  Immune hemolytic anemia and thrombocytopenia  Hypercalcemia  Paraneoplastic cerebellar degeneration
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  NODULAR SCLEROSIS MIXED CELLULARITY LYMPHOCYTE RICH LYMPHOCYE DEPLETED LYMPHOCYTE PREDOMINAN T MC TYPE OF HL MCTYPE IN INDIA ASSOCIATED WITH HIV INCIDENCE EQUAL IN M & F M>F M>F M>F M>F RS CELL VARIANT IS LACUNAR CELL MAXIMUM NO OF RS CELLS MONO NUCLEAR RS CELLS MUMMIFIED, NECROBIOTIC POPCORN CELLS CD 15+, CD 30+ CD 15+, CD 30+ CD 15+, CD 30+ CD 15+, CD 30+ CD 20 +, BCL 6+ & EMA + NOT ASSOCIAT WITH EBV ASSOCIATED WITH EBV NOT ASSOCIAT WITH EBV EXCELLENT PROGNOSIS PROGNOSIS VERY GOOD GOOD POOR PROGNOSIS EXCELLENT PROGNOSIS
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  MORPHOLOGY
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  INVESTIGATIONS  CBC- ANEMIA,EOSINOPHILIA, NEUTROPHILIA  ESR- RAISED  LDH  LFT AND RFT PRIOR TO RX  CHEST RADIOGRAPH – MEDIASTINAL MASS  CT SCAN OF CHEST,ABDOMEN,PELVIS FOR STAGING  BONE MARROW BIOPSY
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  Ann Arbor staging
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  TREATMENT  Patients withlocalised disease are cured 90% of time.  In patients with good prognostic factors, extended field radiotherapy has a high cure rate.  Patients with more extensive disease or those with B symptoms receive a complete course of chemotherapy.
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  Cont….  Chemotherapy regimensused in hodgkins disease ABVD REGIMEN MOPP REGIMEN A- ADRIYAMYCIN M- MECHLORETHAMINE B- BLEOMYCIN O- VINCRISTINE V- VINBLASTINE P- PROCARBAZINE D- DACARBAZINE P- PREDNISONE
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   Today inUS most patients receive ABVD but a weekly chemotherapy regimen administered for 12 weeks called stanford V is becoming increasingly popular.  Patients who relapse after primary chemotherapy can frequently still be cured.
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   The mostserious late side effects include: 1. Acute leukemias 2. Second malignancies- Lung, Breast 3. Coronary artery disease 4. Hypothyroidism 5. Lhermittes’s syndrome 6. Infertility
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  DD OF ALN BIOPSY SUSPICIOUS FER HODGKIN’S DISEASE  INFECTIOUS MONONUCLEOSIS  NON HODGKINS LYMPHOMA  PHENYTOIN INDUCED ADENOPATHY  NON LYMPHOMATOUS MALIGNANCIES
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  THANK YOU