Hodgkin’s lymphoma
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Transcript of Hodgkin’s lymphoma
HODGKIN’S LYMPHOMA
DR. SIDDHARTH
INTRODUCTION Characterized by the 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
“Reed-Sternberg cell”
DIFFERENCE HODGKIN’ LYMPHOMA NON HODGKIN’S
LYMPHOMAMORE 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
SPREAD
CLINICAL FEATURES PAINLESS ENLARGEMENT 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.
UNUSUAL MANIFESTATIONS Severe and unexplained itching Cutaneous disorders such as erythema
nodosum and icthyosis form atrophy. Nephrotic syndrome Immune hemolytic anemia and
thrombocytopenia Hypercalcemia Paraneoplastic cerebellar degeneration
NODULAR SCLEROSIS
MIXED CELLULARITY
LYMPHOCYTE RICH
LYMPHOCYE DEPLETED
LYMPHOCYTE PREDOMINANT
MC TYPE OF HL
MC TYPE 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
ADOLESCENT & YOUNG ADULT
BIPHASIC INCIDENCE
OLD AGE OLD AGE YOUNG MALES
MORPHOLOGY
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
Ann Arbor staging
TREATMENT Patients with localised 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.
Cont…. Chemotherapy regimens used in
hodgkins disease ABVD REGIMEN
MOPP REGIMEN
A- ADRIYAMYCIN M- MECHLORETHAMINE
B- BLEOMYCIN O- VINCRISTINE
V- VINBLASTINE P- PROCARBAZINE
D- DACARBAZINEP- PREDNISONE
Today in US 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.
The most serious late side effects include:
1. Acute leukemias 2. Second malignancies- Lung, Breast 3. Coronary artery disease 4. Hypothyroidism 5. Lhermittes’s syndrome 6. Infertility
DD OF A LN BIOPSY SUSPICIOUS FER HODGKIN’S DISEASE
INFECTIOUS MONONUCLEOSIS NON HODGKINS LYMPHOMA PHENYTOIN INDUCED ADENOPATHY NON LYMPHOMATOUS MALIGNANCIES
THANK YOU