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Reported by J.P. Calibuso, S.M.Macapugay, M.G.Malihan, J.C.Rueda
It is the primary tumors originating the lymphatic system and the most common tumor of the lymphoid system (Black). They are the abnormal overgrowth of one type of leukocyte, the lymphocyte (Ignativicius)
Thomas Hodgkin’s first described the disorder 1832; in the 20th century, realization that the disease is a lymphoid malignancy led to it being renamed Hodgkin’s Lymphoma A potential curable lymphoma with distinct histology , biologic behavior, and clinical characteristics.
Sternberg Cells .Sternberg and Reed Described as giant cells which are Reed Sternberg cells of Hodgkin’s Lymphoma (It is known as the cancer of the lymph) Reed.
Exact cause is unknown Epstein-Barr Virus (EBV) is believe to be a causative agent EBV-associated lymphomas are well documented in clients who have received organ transplant or immune deficiency disease HIV infected patients have a higher prevalence of the disease Risk Factors .
More prevalent in males Age peaking at 15 to 3 years old or 55 years old and above Occurs more frequently with in Jews and along first degree relatives 1% Genetic predisposition contributes to the pathogenesis if HL Siblings of an affected individual have 3 to 7 fold increase risk for developing HL Risk Factors .
Exists in 5 types (WHO) Classic Nodular Sclerosis Mixed cellularity Lymphocyte depleted Lymphocyte rich Nodular lymphocyte Predominant HD Types .
Usually in adolescents and young adults.Nodular Sclerosis – 62 to 80% of all cases of HL. Most commonly observed with patients with HIV. Types . Involves mediastinum and other supra diaphragmatic sites Mixed cellularity – 15 to 30% of all cases of HL. Abdominal lymph nodes and spleen.
Similar with mixed cellularity. Usually older age and usually seen with HIV positive status.Lymphocyte depleted – 1% of all cases of HL. Lymphocyte rich – 5% of cases of HL. Types .
Nodular Lymphocyte Predominant HD – 5% of all cases of HL. Reed sternberg cell are either infrequent or absent Types .
Cancerous transformation from a particular sire in LN Continuing growth in the entire node and becomes replaced With zones of necrosis observing the normal nodular pattern Mechanisms of growth remains unknown Pathophysiology .
Some suggested that the disease progress by extension to adjacent structures May be disseminated by lymphatic cicrculation Hematologic spread may occur Possibility by means of direct infiltration of tissues Pathophysiology .
Asymptomatic Painless lymphadenopathy Enlarged lymph nodes commonly found in supraclavicular and cervical Severe pruritus (early signs) Irrelgular fever (elevated for few days then drops to normal to subnormal for several day) Continuous fever may indicate impeding death Clinical Manifestations .
Jaundice Hepatosplenomegaly Renal failure Progressive anemia accompanied by fatigue. stridor. cyanosis. pleural effussion . dyspnea. chest pain. malaise and anorexia Edema and cyanosis of the face and neck Pulmonary Sx: Non-productive cough.
vertebral compression Paraplegia Nerve pain .Alcohol induced pain in the bone Bone pain.
Multiple lymph node groups on same site on same site of diaphragm Costwold Staging Modified Ann Arbor Staging .Single lymph node group Stage 2 .Stage I .
Multiple lymph node gropu on both sides of diaphragm Stage 4 .Multiple extranodal sites on lymph nodes and extranodal disease Costwold Staging Modified Ann Arbor Staging . Stage 3 .
sampling of pleural effusion. CNS evaluation of lumbar puncture. CT scan of chest. serum creatinine and alkaline phosphatase. abdomen and pelvis. positron emission tomography (PET). ESR. lactate dehydrogenase. Blood studies: CBC. Biopsy: bone marrow biopsy. HIV test Diagnostic procedure .Imaging: anteroposterior and lateral chest radiography.
Thyroid dysfunction Thyroid cancer Sexual dysfunction Male impotence Male and female infertility Female dyspareunia Infection (Herpes Zoster or Varicella) Pulmonary dysfunction Pneumonitis Complications .
- - Radiation Therapy Involves three locations: the mantle. combined chemotherapy and radiation therapy Medical Management . In clinical stage I and II disease. the para-aortic region and the pelvis.
Prednisone .Chemotherapy . Vincristine(Oncovin) Procarbazine. Vinblastine.ABVD (Doxorubicin (adriamycin).MOPP (mechlorethamine. Dacarbazine) Medical Management . Bleomycin.
Predinose) ESHAP (Etoposide. Methyprednisolone. Carboplatin. Etoposide) DHAP (Cisplatin. Salvage Chemotherapy - ICE (Ifosfamide. Cytarabine. Cytarabine. Cisplatin Medical Management .
Predinose) ESHAP (Etoposide. Etoposide) DHAP (Cisplatin. Cisplatin Hematopoetic Stem Cell Transplant Medical Management . Salvage Chemotherapy - - ICE (Ifosfamide. Carboplatin. Cytarabine. Methyprednisolone. Cytarabine.
Comprises a group of malignacies with a common origin in the lymphoid cells. All lymphoid cancer the do not have the Reed-Sternberg Cell Non-Hodgkin’s Disease .
environmental factors. Most common in males Age 50s to 60s White people are high risk Etiology and Risk Factors . herpes virus. HTLV-1. caposis sarcoma).Result from chromosomal translocation. helicobacter pylori. immunodeficiency states and chronic inflammation. infections(EBV.
Abnormal proliferation of neoplastic lymphocytes occurs Cell remains fixed at one phase of development and continue proliferate Clinical manifestations are due to mechanical obstruction of the enlarged lymph nodes Lymphocytic infiltration of the abdomen or oropharynx also can occur Pathophysiology .
Clinical Manifestation . axillary. back pain. Some clients have retroperitoneal and abdominal masses with abdominal fullness. and femoral) Swelling is generally painless Extranodal sites of involvement are the nasopharynx. GI tract. testes.Enlarge lymph node (cervical. ascites and leg swelling. and soft tissue. thyroid. inguinal. bone.
Clients may also experience systemic B symptoms. bone cancer. . lung cancer. syphilis. and weight loss. Other Conditions Tuberculosis. including night sweats.. fever. Cont’d. systemic lupus erythematous.
lymphocytic. poorly differentiated . histocytic Diffuse. mixed. . lymphocytic Diffuse. well differentiated. lymphocytic. lymphocytic and histocytic - Intermediate grade Nodular. and histocytic Rappaport Staging .Nodular. lymphocystic.Low grade . mixed.diffuse.Nodular.
hidtocytic Diffuse. - - High grade Diffuse. lymphoblastic Diffuse. uundifferentiated Cont’d… .
CBC. ESR. and peripheral blood smear Blood cultures Lymph node biopsy CT scan MRI Bilateral bone marrow biopsies Diagnostic procedures .
Ibritumomab Tiuxetan (Zevalin). Alemtuzumab (Campath) Corticosteroids Medical Management .Eradication of Tumor Cells/Surgery Radiation and Chemotherapy Monoclonal antibodies (Rituximab (Rituxan).