HODGKIN’S LYMPHOMA
LYMPHOMA
• THEY ARE PROGRESSIVE NEOPLASTIC CONDITION OF LYMPHORETICULAR
SYSTEM ARISING FROM STEM CELLS.
• THEY ARE HETEROGENOUS GROUP OF LYMPHOPROLIFERATIVE
MALIGNANCIES RESULTING FROM CLONAL EXPRESSION OF TUMOR CELLS
DERIVED FROM B,T OR NK CELLS.
• CLONAL PROLIFERATION OF LYMPHOID CELLS WITH VARIOUS DEGREE OF
MATURITY.
HODGKIN LYMPHOMA
• TYPE OF MALIGNANT LYMPHOMA IN WHICH REED STERNBERG CELLS ARE
PRESENT IN A CHARACTERISTIC BACKGROUND OF REACTIVE INFLAMMATORY
CELLS OF VARIOUS TYPES, ACCOMPANIED BY FIBROSIS OF VARYING DEGREE.
(EXCEPT NLPHL)
REED STERNBERG CELL
• LARGE CELL (>45UM IN DIAMETER)
• BINUCLEATE OR BILOBED CENTRAL NUCLEUS
• OWL EYE APPEARANCE – EACH NUCLEUS WITH LARGE ACIDOPHILIC CENTRAL
NUCLEOLI SURROUNDED BY A CLEAR HALO.
• REQUIREMENT OF REED-STERNBERG CELL FOR INTIAL DIAGNOSIS IS
ABSOLUTE.
• CURRENT STUDIES INDICATE THE RS CELLS OF HL ARE LYMPHOCYTIC IN
NATURE AND IN GREAT MAJORITY OF CASES, ARE OF B-CELL ORIGIN
WHO CLASSIFICATION OF HL
CLASSICAL HL:
1. NODULAR SCLEROSIS
2. MIXED CELLULARITY
3. LYMPHOCYTE RICH
4. LYMPHOCYTE DEPLETED
NON CLASSICAL HL:
5. NODULAR LYMPHOCYTIC PREDOMINANT HL
RYE CLASSIFICATION OF HL
1. LYMPHOCYTIC PREDOMINANCE
2. MIXED CELLULARITY
3. NODULAR SCLEROSIS
4. LYMPHOCYTIC DEPLETION
ETIOLOGY
1. INFECTIOUS MONONUCLEOSIS, EPSTEIN BARR VIRUS
2. HIV INFECTION, VITAMIN D DEFICIENCY
3. GENETIC MONOCLONAL B DISORDER
4. SYSTEMIC LUPUS ERYTHEMATOSUS, RHEUMATOID ARTHRITIS.
5. ORGAN TRANSPLANTATION WITH IMMUNOSUPPRESSION.
6. MALES> FEMALES.
7. WHITES>BLACKS>ASIANS
CLINICAL FEATURES
1. BIMODAL PRESENTATION.
2. PAINLESS PROGRESSION ENLARGEMENT OF LYMPH NODES .
3. LYMPH NODE – SMOOTH, FIRM, NON MATTED, NON TENDER , INDIAN
RUBBER CONSISTENCY.
4. MOST COMMON – CERVICAL LYMPH NODES(80%)
5. OTHER INCLUDES – AXILLARY, MEDIASTINAL(50%), IGUINAL, ABDOMINAL.
CLINICAL FEATURES
1. PAIN AFTER CONSUMPTION OF ALCOHOL( LOW SENSITIVITY AND HIGH
SPECIFICITY). PAIN APPEARS WITHIN 3 MINUTES OF CONSUMING ALCOHOL.
2. OTHER LESS COMMON SYMPTOMS- PRURITIS, ERYTHMA NODOSUM,
NEPHROTIC SYNDROME ,THROMBOCYTOPENIA,HYPERCALCEMIA
ANN -ARBOR CLINICAL STAGING
1. STAGE 1: CONFINED TO ONE GROUP OF LYMPH NODE
2. STAGE 2:MORE THAN ONE GROUP OF LYMPH NODE ON SIDE OF DIAPHGRAM
3. STAGE 3:NODES INVOLVED ON BOTH SIDES OF DIAPHRAGM
4. STAGE 4:EXTRA NODAL INVOLVMENT ( BONE , LIVER)
SUFFIXES-
S - SPLEEN INVOLVED
B - PRESENCE OF CONSTITUITONAL SYMPTOMS
A – ABSENCE OF CONSTITUTIONAL SYMPTOMS
‘B’ SYMPTOMS
1. FEVER(>38 DEGREE CELCIUS):PEL EBSTEIN FEVER
2. DRENCHING NIGHT SWEATS
3. WEIGHT LOSS(>10% IN 6 MONTHS)
PROBLEMS IN HL
1. PLEURAL EFFUSION – RESPIRATORY DISCOMFORT
2. SVC OBSTRUCTION
3. OPPORTUNISTIC INFECTIONS-MYCOBACTERIA,CYTOMEGALOVIRUS,HERPES
ZOSTER
4. BRONCHOPNEUMONIA,SEPTICAEMIA
5. IMMUNOSUPPRESSION
6. RISK FOR OTHER MALIGNANCIES
INVESTIATIONS
1. BLOOD(HB%, ESR, PERIPHERAL SMEAR, BLOOD UREA,SERUM
CREATININE,SERUM ALKALINE PHOSPHATASE)
2. FNAC OF LYMPH NODES
3. EXCISION BIOPSY OF LYMPH NODES.
1. CHEST X RAY – TO LOOK FOR MEDIASTINAL LYMPH NODES AND PLEURAL
EFFUSION.
2. ULTRASOUND ABDOMEN- TO LOOK FOR INVOLVEMENT OF LIVER, SPLEEN,
ABDOMINAL LYMPH NODES.
3. CT SCAN OF MEDIASTINUM/CHEST.
4. BONE MARROW BIOPSY
TREATMENT
1. EARLY FAVOURABLE STAGE – EXTENDED FIELD RADIATION
2. EARLY UNFAVOURABLE STAGE – EXTENDED RADIATION +CHEMOTHERAPY
3. ADVANCED STAGE – EXTENSIVE CHEMOTHERAPY WITH LOCAL RADIATION
UNFAVOURABLE SIGNS
1. LARGE MEDIASTINAL MASS
2. EXTRANODAL DISEASE
3. ELEVATED ESR
4. FOUR OR MORE INVOLVED REGIONS
5. PRESENCE OF B SYMPTOMS
6. ANAEMIA<10GM% , LOW SERUM ALBUMIN LEVEL <4GM%
7. AGE MORE THAN 50
8. MALE GENDER
(FIRST FIVE PARAMETERS ARE MOST IMPORTANT)
CHEMOTHERAPY FOR HL
1. ABVD REGIME:
ADRIAMYCIN- 30MG
BLEOMYCIN – 10MG
VINBLASTINE- 6MG
DACARBAZINE- 350MG
2. STANFORD V REGIME
ADRIAMYCIN
BLEOMYCIN
VINCRISTINE,VINBLASTINE
MECHLORETHAMINE
ETOPOSIDE
PREDNISOLONE
3. BEACOPP REGIME
BLEOMYCIN
ETOPOSIDE
ADRIAMYCIN
CYCLOPHOSPHAMIDE
ONCOVIN-VINCRISTINE
PROCARBAZINE
PREDNISOLONE
1. STAGE I AND II : MAINLY RADIOTHERAPY
2. STAGE III AND IV : MAINLY CHEMOTHERAPY
PROGNOSIS
1. STAGE I AND II – 80%
2. STAGE IIIA – 70%
3. STAGE IIIB AND IV - <40%
PROGNOSTIC FACTORS
1. STAGE I AND II HAS GOT BETTER PROGNOSIS
2. LYMPHOCYTIC PREDOMINANCE HAS GOT BETTER PROGNOSIS
3. STAGE ‘A’ WITHOUT CONSTITUTIONAL SYMPTOMS HAS GOT BETTER
PROGNOSIS
4. ANAEMIA<10GM%,HYPOALBUMINEMIA<4GM%, LYMPHOCYTE
COUNT<600/MM3, WBC COUNT>15,000/MM3, AGE>45YEARS,
INVOLVEMENT OF BONE AND LIVER , HIGH LDH – POOR PROGNOSTIC
FACTORS
LONG TERM COMPLICATIONS AFTER
THERAPY
1. SECONDARY MALIGNANCIES – AML, CARCINOMA BREAST,THYROID,LUNG
2. HYPOTHYROIDISM
3. SHORT STATURE
4. STERILITY
5. PULMONARY DYSFUNCTION
6. RECURRENT INFECTION
7. DENTAL CARIES
8. ISCHAEMIC HEART DISEASE
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