FN: Hodgkins lymphoma

Question 1

Epi

Answer 1

M>F =@:1 (esp. in paeds)
Bimodal age incidcen: 20-29yrs and >60yrs
May be association with EBV

Question 2

FEatures

Answer 2

Lymphadenopathy
B symptoms
OTher

Question 3

Lymphadenopathy

Answer 3

Painless
Asymmetric
Spreads contiguously to adjacent LNS
Cervical nodes in 70% (also axillary and inguinal)
May be alcohol-induced LN pain
Mediastinal LN may - mass effects
1. SVC obstruction
2. Bronchial obstruction

Question 4

B symptoms

Answer 4

Fever
Night sweats
Wt. loss

Question 5

Other symptoms

Answer 5

Itch
Pel Ebstein Fever: cyclical fever
Hepato- and/or spleno-megaly

Question 6

Investigations

Answer 6

1. FBC, film, ESR, LFT, LDH, Ca - raise ESR and reduced HB = worse prognosis
2. LN excision biopsy or FNA - Reed-sternbery cells )owls eye nucleus)
3. Staging: CT/MRI chest, abdomen, pelvs
4. BM biopsy if B symptoms or stage 3/4 disease

Question 7

staging

Answer 7

Ann Arbour system

Question 8

Ann Arbour system

Answer 8

1. Single LN region
2. > 2 nodal are on same side of diaphragm
3. Nodes on both sides of diaphragm
4. Spread beyond nodes e.g. liver, BM
   - -> + B if constitutional symptoms

Question 9

Management

Answer 9

Chemo, radio or both
ABVD regimen
BMT for relapse

Question 10

Prognosis

Answer 10

Depends on stage and grade
1A >95% 5 yrs
4B