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HODGKIN’S DISEASE

Dr. Tjatur Winarsanto SpPD RST Ciremai 2011

Extranodal presentation are rare.Hodgkin Disease • Definition: neoplastic disorder with development of specific infiltrate containing pathologic Reed-Sternberg cells. It usually arises in lymph nodes and spreads to contiguous groups. Disease is associated with defective cellular immunity. .

bimodal age distribution : 15-35 years and above 50 years .7:1 .male predominance M:F = 1.2-4 cases per 100000 population / year .Hodgkin Disease • Incidence: .

Clinical Presentation • Nontender lymph nodes enlargement ( localised ) – neck and supraclavicular area – mediastinal adenopathy – other ( abdominal. weakness. chest pain. extranodal disease ) 60-80% 50% • systemic symptoms (B symptoms) – fever – night sweats – unexplained weight loss (10% per 6 months) 30% • other symptoms – – – – fatigue. bowel disturbances. shortness of breath. ascites bone pain . pruritus cough . vena cava syndrome abdominal pain.

Diagnosis of Hodgkin Disease • is based on microscopic examination of lymph node or other involved tissue • it requires identification of diagnostic ReedSternberg cells .

Pathologic Classification WHO • Classical Hodgkin disease – – – – lymphocyte rich nodular sclerosis 1 and 2 mixed cellularity lymphocyte depletion (LR) (NS) (MC) (LD) • Hodgkin lymphoma with lymphocyte predominance (LP) .

Bulky disease ( > 1/3 widening of mediastinum.Staging Classification Ann Arbor modified by Cotswolds • Stage I: involvement of single lymph node region or lymphoid structure • Stage II: involvement of two or more lymph node regions on same side of diaphragm • Stage III: involvement of lymph node regions or structures on both sides of diaphragm III1: with splenic hilar. Symptomatic (B symptoms) X. Involvement of a single. > 10cm max.iliac.celiac. extranodal site .dimension of nodal mass) E.portal nodes III2: with para-aortic. localised. Asymptomatic B.mesenteric nodes • Stage IV: involvement of extranodal site(s) A.

Staging evaluation for Hodgkin’s Disease (1) • Essential – – – – pathologic documentation by hemopathologist physical examination documentation of B symptoms laboratory evaluation • • • • complete blood count. abdomen and pelvis bone marrow aspiration / biopsy (bilateral) . ESR liver function tests renal function tests lactate dehydrogenase – – – – chest radiograph ultrasonography CT scan of chest.

Staging evaluation for Hodgkin’s Disease (2) • Essential under certain circumstances – – – – – – – liver biopsy gallium scan technetium bone scan bone radiographs MRI bipedal lymphangiogram staging laparotomy • Useful but not essential tests – cell-surface marker phenotypic analysis – gene rearrangement analysis .

radiotherapy) .Treatment of Hodgkin Disesae (1) With appropriate treatment about 85% of patients with Hodgkin disease are curable • I A.B: radiation therapy • II A : combination chemotherapy + radiotherapy • IIB IIIA.B : combination chemotherapy (+/.B IVA.

Treatment of Hodgkin Disesae (2) • Radiation therapy – mantle field – paraaortic field – pelvic field dose: 35-40 Gy/T 80-90% RC • Combination chemotherapy – ABVD – BEACOPP 80% RC 90% RC .

relapse: • Second-line noncross-resistant regimens CR 30-40% DFS 10-25% – DHAP – CEP – EVAP • High dose chemotherapy with autologous stem cell transplantation .resistance.Treatment of Hodgkin Disesae (3) Salvage therapy.