Chapter 16: Hodgkin's lymphoma

Question 1

What are lymphomas?

Answer 1

Lymphomas are malignancies of lymphocytes that usually accumulate in lymph nodes causing lymphadenopathies.

Question 2

What differentiates Hodgkin’s from Non-Hodgkin’s lymphomas?

Answer 2

Hodgkin’s lymphomas exhibit Reed-Sternberg cells.

Question 3

What is the pathogenesis of Hodgkin’s lymphomas?

Answer 3

Hodgkin’s lymphoma is caused by the malignant transformation of B-lymphoid cells. The characteristic RS cells seen typically posses crippled Ig genes.

Question 4

What virus is associated with Hodgkin’s lymphoma?

Answer 4

EBV is associated with Hodgkin’s lymphoma although no causal relationship has been established.

Question 5

What clinical feature is most commonly associated with Hodgkin’s lymphoma?

Answer 5

Painless, non-tender, asymmetrical enlargements of superficial lymph nodes.

Question 6

What constitutional symptoms are seen in Hodgkin’s lymphoma?

Answer 6

(1) fever
(2) pruritis
(3) alcohol induced pain
(4) weight loss
(5) fatigue
(6) cachexia.

Question 7

What hematologic abnormalities are seen in Hodgkins’ lymphoma?

Answer 7

HL eventually progresses to pancytopenia

(1) normocytic, normochromic anemia
(2) Neutrophilia/eosinophilia
(3) Lymphopenia (in advanced disease)
(4) Thrombocytopenia (in advanced stages)

Question 8

How is HL diagnosed?

Answer 8

HL is diagnosed by histologic examination with the findings of multinucleate polyploid RS cells.

Question 9

What is the immunophenotype of mononuclear Hodgkin’s cells?

Answer 9

CD30+, CD15+, and B-cell antigen negative.

Question 10

What are the 5 types of HL?

Answer 10

(1) Nodular sclerosing
(2) Mixed cellularity
(3) Lymphocyte depleted
(4) Lymphocyte rich
(5) Nodular lymphocyte predominant

Question 11

What are the distinguishing characteristics of Nodular sclerosis HL?

Answer 11

(1) Collagen bands from the node capsule surround the abnormal tissue.
(2) Lacunar RS cells.
(3) Frequent eosinophilia

Question 12

What are the distinguishing characteristics of Mixed cellularity HL?

Answer 12

Numerous RS cells with intermediate numbers of lymphocytes.

Question 13

What are the distinguishing characteristics of Lymphocyte depleted HL?

Answer 13

(1) Usually numerous RS cells
(2) sparse lymphocytes
(3) Lymph node fibrosis

Question 14

What are the distinguishing characteristics of Lymphocyte rich HL?

Answer 14

(1) Scanty RS cells
(2) many small lymphocytes
(3) both nodular and diffuse

Question 15

What are the distinguishing characteristics of Nodular lymphocyte predominant HL?

Answer 15

(1) absent RS cells

(2) abnormal polymorphic B cells.

Question 16

How is clinical staging of HL achieved?

Answer 16

(1) clinical examination
(2) imaging (CT, XR, MRI, PET)
(3) possibly trephine biopsy or liver biopsy as needed.

Question 17

What do the classifications A and B mean in relation to the staging of HL?

Answer 17

They distinguish whether or not constitutional symptoms are present.

Question 18

How is HL treated?

Answer 18

Radiotherapy, chemotherapy, or a combination of both.

Question 19

What is the staging system for HL?

Answer 19

(1) stage 1 (single lesion on 1 side of diaphragm)
(2) Stage II (multiple lesions on one side.)
(3) Stage III (single lesion on each side)
(4) stage IV (multiple lesions on each side)

Question 20

When is radiotherapy most useful for treating HL?

Answer 20

Radiotherapy is 80% effective in treating patients with type I or II HL.

Question 21

When is chemotherapy most used to treat HL?

Answer 21

chemotherapy is used most frequently in stage III or IV HL.

Question 22

What is the most commonly used chemotherapy for HL?

Answer 22

ABVD (adriamycin, bleomycin, vinblastine, and dacarbazine.

Question 23

What treatment is used if a patient relapses?

Answer 23

Alternative chemotherapy with or without radiotherapy and possible stem cell transplant.

Question 24

What is the prognosis for HL?

Answer 24

5 year survival rates range from 50-90% based on age, stage and histology.
10 year survival is 80%

Question 25

What are some of the long term effects of HL treatment?

Answer 25

secondary malignancy, sterility, and myocardial infarction.