Hodgkin Lymphoma Flashcards
Give an overview of Hodgkin lymphoma
B cell lymphoma
Diagnosis is based on presence of reed sternberg cells and mononuclear hodgkin cells
It is an usualy morphology in that more of the cells are simply normal reactive cells and the cancer cells are actually in the minority
What is the epidemiology of hodgkin lymphoma?
There is a bimodal age incidence with one peak in late adolescence/young adulthood and the second peak beginning over the age of 60
This is different in developing countries where teh incidence shifts to younger and this is thought to be due to infection of EBV at a young age
What are the clinical presenting symptoms of hodgkins?
Lymphadenopathy that is often cervical Hepatomegaly Splenomegaly Fever Weight loss Night Sweats Itch Alcohol related symptoms Cough Episodic fever PAin in the lymph node following alcohol ingestions
What are the aetiological factors of HL?
EBV is a major aetiological factor
Molecularly it infects the cHL patients and these patients havea . higher EBV Ab titre and the raised EBV Ab preceds lymphoma. There is an increased risk of developing cHL following glandular fever. The CD4 cells are needed to mediate the disease
EBV rescues B cells with crippling IgH mutations from apoptosis before they leave the germinal centre
LMP1 induces B cel activation markers, adhesion molecules and upregulates anti-apoptosis genes
LMP1 also activates JAK/STAT NfKb pathways so they become ligand independent
LMP2A allows B cells to survive without signaling from Ig
What is the evidence for the role of EBV in classical HL?
There is a 3/4 fold increase in incidence after infection mononucleosis
High titre of antibodies to lytic phase antigens predate HL
Clonal EBV in hodgkin and reed sternberg cells in 40-50% of patients
there is seasonal variation and association with overcrowding and deprivation suggesting infective aetiology
What stain is used to dye HL biopsies?
Haemotoxylin and Eosin
What is another aetiological factor?
HIV
