hodgekin lymphoma

Question 1

what is hodgkin lymphoma?

Answer 1

Hodgkin lymphoma (HL) is a neoplasm (exhibiting uncontrolled growth) of B lymphocytes that was named for Thomas Hodgkin, the British pathologist who rst described it. This neoplasm contains a characteristic tumor cell called the Reed-Sternberg cell that represents usually less than 1% of the cellular in ltrate in affected tissues.32 For a long time HL was referred to as Hodgkin’s disease and NHL as non-Hodgkin’s lymphoma. Refer- ences cited in this book use both sets of identi cation.

Question 2

what is etiology, pathology, and complications with it?

Answer 2

The cause of HL is unknown, but EBV frequently is present (50% of cases in the Western world) in malig- nant lymphocytes.33 This virus can immortalize B cells in vitro and encodes a protein known as latent mem- brane protein 1 that has oncogenic potential.34 Increased risk is associated with presence of the disease in rst- degree relatives and with human immunode ciency virus (HIV)-seropositive status.32,33

Enlarging tumorous nodes may cause lung or vascular obstruction, and enlarging mediastinal nodes can cause cough, shortness of breath, or dysphagia. The disease spreads predictably over weeks to months, rst to other lymphoid sites (other lymph nodes and spleen) and then hematogenously to extranodal sites, including bone marrow, liver, and lung. Without treatment, death occurs as a result of complications from bone marrow failure or infection.

Question 3

what is non-hodgkin lymphoma?

Answer 3

Non-Hodgkin lymphoma (NHL) comprises a large group of lymphoproliferative disorders classi ed as of B cell or T cell origin. More than 80% of these neoplasms are of B cell origin.6 The World Health Organization (WHO) classi cation system uses immunophenotype, cytogenetics, and epidemiologic/etiologic factors to dis- tinguish the many types of NHL. Four major categories of NHL are described: precursor (immature) B cell neo- plasms, peripheral (mature) B cell neoplasms, precursor (immature) T cell neoplasms, and peripheral (mature) T cell and natural killer (NK) cell neoplasms.6,35 Subcatego- ries are based on pattern of distribution (diffuse or nodular), cell type (lymphocytic, histiocytic, mixed), and degree of differentiation of cells (good, moderate, poor). Of the more than 20 types of NHL that have been identi- ed, diffuse large B cell and follicular lymphomas account for about 60% of cases.36

Question 4

what is the etiology, pathophysiology, and complications?

Answer 4

The cause of NHL is unknown, but genetic factors, infec- tious agents, herbicides, radiation, and some forms of chemotherapy are increasingly recognized as causative agents. At the molecular level, malignant lymphocytes have chromosomal translocations or mutations in genes that regulate lymphocyte growth (BCL6) or survival (BCL2). Persistent in ammation from Helicobacter pylori infection of the stomach contributes to gastric lymphoma. Oncogenic viruses such as EBV, Kaposi sarcoma herpesvirus (KSHV), and retroviruses are associated with several types of NHL. Patients withautoimmune disease (Sjögren syndrome) or immunode- ciency states (acquired immunode ciency syndrome [AIDS], after chemotherapy) are at increased risk for the disease.36
The course of NHL varies from highly proliferative and rapidly fatal disorders (aggressive) to slowly progressing (indolent) malignancies that are tolerated for 10 to 20 years.38,40 Tumorous cells behave in similar fashion to that for the cell of origin: Tumorous B cells home to follicular regions of lymph nodes, and T cells have a propensity for paracortical T cell zones. These neo- plasms cause tumorous enlargements and abnormalities of the immune system. Tumors often are widespread at the time of diagnosis and more variable in location (involving various organs such as liver and spleen) than in Hodgkin disease. Anemic and leukemic manifesta- tions are common.

Question 5

if the lump is rock hard what should you conclude?

Answer 5

Lymph nodes that are hard and painless have increased significance for malignant or granulomatous disease and typically merit further investigation. For example, the nodes of nodular sclerosing Hodgkin’s lymphoma are firm, fixed, circumscribed, and rubbery.

Question 6

what other neck lumps could you consider in a differential diagnosis?

Answer 6

• Viral infection
• Bacterial infection
• Systemic lymphoadenopathy (HIV)
• Thyroglossal duct cyst
• Hodgkin’s lymphoma
• Metastatic tumors
• Actinomycosis
• Dermoid cyst
• Epidermoid cyst