Post on 14-Apr-2018
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Lymphoma
EXPERT LECTURE
FACULTY OF MEDICINE
UNIVERSITY OF BRAWIJAYA MALANG
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Lymphoma
The incidence of Hodgkin's disease appears fairlystable, with ~7800 new cases diagnosed in 2004 inthe United States.
Hodgkin's disease is more common in whites than inblacks and more common in males than in femal
Incidence
Superficial lymphadenopathy with cervicalnodes
Fever and drenching night sweats
ClinicalFeatures
Eestablished by review of an adequatebiopsy specimen and depends on findingmultinucleated Reed-Sternberg (RS) cell
Diagnosis
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Reed-sternberg cell(Owls eyes)
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Fig. The right cervical and axillar lymphadenopathy
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Non Hodgkin
Lymphoma
Most NHLs are neoplasm of B-lymphocyte originwith characteristic cell membrance surfacemarkers. NHL are more frequent in the elderly and morefrequent in men.
Incidence
Superficial lymphadenopathy, with cervicalnodes being most common
Fever, weight loss and night sweats
ClinicalFeatures
Lactate dehydrogenase (LDH)2-microglobulinUric acidCreatinine
LaboratoryFeatures
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Non Hodgkin Lymphoma
The diagnosis of NHL requires adequate tissueand experienced hematopathologist. Most often,
it is necessary to perform biopsies of peripherallymph nodes rather than rely on needleaspirates because the architecture of the tissueis important to the classification of NHL.
Diagnosis
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1.Describe histologic classification of Hodgkins
disease !
2.Describe in brief The Ann Arbor Staging System for
Hodgkins Disease !
3.Describe clinical features and laboratory findings todiagnose Hodgkins disease !
4.Describe in brief the treatment of Hodgkins disease !
5.Describe etiology of non-Hodgkins lymphoma !
6.Describe clinical features and laboratory findings to
diagnose non-Hodgkins lymphoma !7.Describe in brief The International Prognostic Index
for non-Hodgkins lymphoma !
MODULE TASK
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Question 1.
Describe histologic classification of Hodgkins
disease !
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1. Lymphocyte-predominat HD limited disease (stage I or II) in the neck
2. Nodular sclerosis HD : the most common subtype,
associated with mediastinal mass & hilar
lymphadenopathy in addition to disease in the neck3. Mixed cellularity HD
4. Lymphocyte-depleted HD
The mixed cellularity HD & lymphocyte-depleted HD aremore common in constitusional symptom and advace
disease.
Histologic classification
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Question 2.
Describe in brief The Ann Arbor Staging
System for Hodgkins Disease!
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Stage Definition
I Involvement of a single lymph node region or lymphoid structure (e.g., spleen,
thymus, Waldeyer's ring)
II Involvement of two or more lymph node regions on the same side of the diaphragm
(the mediastinum is a single site; hilar lymph nodes should be considered
lateralized and, when involved on both sides, constitute stage II disease)
III Involvement of lymph node regions or lymphoid structures on both sides of the
diaphragm
III1 Subdiaphragmatic involvement limited to spleen, splenic hilar nodes, celiac nodes,or portal nodes
III2 Subdiaphragmatic involvement includes paraaortic, iliac, or mesenteric nodes plus
structures in III1
IV Involvement of extranodal site(s) beyond that designated as E. More than one
extranodal deposit at any location. Any involvement of liver or bone marrow
A No symptoms
B Unexplained weight loss of >10% of the body weight during the 6 months before
staging investigation
Unexplained, persistent, or recurrent fever with temperatures >38C during the
previous month
Recurrent drenching night sweats during the previous month
E Localized, solitary involvement of extralymphatic tissue, excluding liver and bone
marrow
Table 1. The Ann Arbor Staging System for Hodgkins Disease
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Question 3.
Describe clinical features and laboratory
findings to diagnose Hodgkins disease !
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CLINICAL FEATURES
Superficial lymphadenopathy with cervical nodesUsually begins in the neck and spreads to adjacent lymph nodes
with occasional spread to nonlymphoid structure e.g. the
mediastinum into the lung
The lymph nodes are usualy nontender and firm or rubbery
Fever (>38o C), drenching night sweats and/or weight loss of> 10% of usual weight a poor prognosis
Pruritus and alcohol-induced pain in areas of disease involment
LABORATORY FINDINGS
In the peripheral blood : anemia, neutrophilia, eosinophilia,
monocytosis, lymphocytopenia, and trombocytosis or
thrombocytopenia
Liver function test may be abnormal, the LDH may be elevated
Hodgkins Disease
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DIAGNOSIS
Biopsy specimen : multinucleated Reed-Sternberg (RS) cellsRS cells or their variants are usually large cells with 2 nuclei,
each with a prominent nucleolus that sometime give it an owls
eyes appearance (Figure 1).
FNA is inadequate for initial diagnosis
Determination of an accurate anatomic stage is an importantpart of the evaluation. The staging system is the Ann Arbor
staging system originally developed for Hodgkin disease
Hodgkins Disease..(contd)
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Question 4.
Describe in brief the treatment of Hodgkins
disease !
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Localized Hodgkin's disease are cured >90%
Extended field radiotherapy in patients with goodprognostic
factors a high cure rate
Chemotherapy initial therapy in all stages of Hodgkin's
disease
Combination chemotherapy and radiotherapy
Relapse after primary therapy of Hodgkin's disease can
frequently still be cured.
Autologous bone marrow transplantation can cure half of
patients who fail effective chemotherapy regimens
Treatment of Hodgkins Disease
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Question 5.
Describe histologic classification of Hodgkins
disease !
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