Hodgkin's Lymphoma Flashcards
What are lymphomas
Lymphomas are a group of diseases caused by malignant lymphocytes that accumulates in lymph nodes and cause a characteristic clinical features of lymphadenopathy
Group of diseases caused by malignant lymphocytes that accumulates in lymph nodes and cause a characteristic clinical features of lymphadenopathy
Lymphomas
True or false occasionally lymphomas may spill over into blood (leukemic face) or infiltrate organs outside the lymphoid tissue
True
What are the two major subdivisions of lymphomas
Non-Hodgkin’s lymphoma and Hodgkins lymphoma
What is the main histological difference between Hodgkins and Non-Hodgkins Lymphoma
The presence of Reid Sternberg cells in Hodgkins lymphoma
Define Hodgkin’s disease
This is a lymphoma in which Reid Sternberg cells are found in the disease tissue
Which virus genome has been detected in 50% or more of cases in Hodgkins tissue
Epstein bar virus
What is the peak incidence of Hodgkins Lymphoma
Young adults
What is the gender predominance of Hodgkin’s disease
2 : 1 male predominance
True or false
Hodgkin’s disease can present at any age but is rare in children
True
Describe the lymph nodes that most patients with Hodgkins lymphoma present with
Painless Nontender Asymmetrical Firm Discrete Rubbery enlargement of superficial lymph nodes
Hodgkin’s lymphoma in which group of nodes present in 60 to 70% of patients
Cervical nodes
Hodgkin’s lymphoma in which group of nodes present in 10-15% of patients
Axillary Nodes
Hodgkin’s lymphoma in which group of nodes present in 6-12% of patients
Inguinal Nodes
Splenomegaly occurs during the course of Hodgkin’s disease in what percent of patients
50%
List some clinical features of Hodgkin’s disease
Clinical splenomegaly
Cutaneous Hodgkins Disease (late stage)
Constitutional symptoms: fever, pruritis, alcohol induced pain
What is the colour and size of RNCs in Hodgkins Disease
Normochromic
Normocytic
What blood line is increased in 1/3rd of pts with Hodgkin’s lymphoma
Neutrophilia
Neutrophils
What is the platelet count during early Non Hodgkins disease
Normal or increased
Reduced in later stages
What is the ESR and C reactive protein levels in Hodgkins disease
Raised
What is serum lactate dehydrogenase (LDH) levels in Hodgkins Disease
Raised in 30-40% of cases
How is the diagnosis of Hodgkins Disease made
Histological Examination of an excised lymph node
What are the five classic Hodgkin’s lymphoma classifications
Nodular Sclerosis Mixed Cellularity Lymphocyte depleted Lymphocyte rich Nodular Lymphocyte pre- dominant
What are the most frequent types of Hodgkin’s lymphoma
Nodular Sclerosis
Mixed Cellularity
Which type of Hodgkin’s lymphoma has the most favorable prognosis
Nodular Lymphocyte predominant
True or false nodular lymphocytes predominant shows Reed Sternberg Cells
False it also has many features of non-Hodgkin’s lymphoma and may be treated as such
Describe Hodgkin’s lymphoma with mixed cellularity
The Reed Sternberg cells are numerous and lymphocytes numbers are intermediate
The Reed Sternberg cells are numerous and lymphocytes numbers are intermediate
Hodgkins “Mixed Cellularity “
3rd highest related to EBV, 1st is Lymphocyte depleted
Describe “nodular lymphocyte predominant” Hodgkin’s disease
Reed-Sternberg cells are absent and abnormal polymorphic B cells are present
Reed-Sternberg cells are absent and abnormal polymorphic B cells are present
“nodular lymphocyte predominant” Hodgkin’s disease
Describe” lymphocytes rich” Hodgkin’s lymphoma
Scanty Reed Sternberg cells
Multiple small lymphocytes with a few eosinophils and plasma cells
Scanty Reed Sternberg cells
Multiple small lymphocytes with a few eosinophils and plasma cells
“lymphocytes rich” Hodgkin’s lymphoma
Describe Nodular Sclerosis Hodgkin’s lymphoma
The cellular infiltrates may be off the lymphocyte predominant, mixed Cellularity or lymphocyte depleted type
The cellular infiltrates may be off the lymphocyte predominant, mixed Cellularity or lymphocyte depleted type
Nodular Sclerosis Hodgkin’s lymphoma
Describe lymphocyte depleted Hodgkin’s lymphoma
There is either a reticular pattern with dominance of Reed Sternberg cells and sparse numbers of lymphocytes
OR
A diffuse fibrosis pattern where the lymph node is replaced by this ordered connective tissue containing very few lymphocytes
There is either a reticular pattern with dominance of Reid Sternberg cells and sparse numbers of lymphocytes
OR
A diffuse fibrosis pattern where the lymph node is replaced by this ordered connective tissue containing very few lymphocytes
lymphocyte depleted Hodgkin’s lymphoma
The selection of appropriate treatment of Hodgkin’s disease, depends on what?
Accurate staging of the extent of disease
How is staging of Hodgkin’s disease performed
By thorough clinical examination together with chest x-ray and CT scan/PET scan to detect intrathoracic intra-abdominal or pelvic disease
Describe stage 1 Hodgkin’s lymphoma
Indicates node involvement in one lymph node area
Which stage of Hodgkin’s disease is this
“Indicates node involvement in one lymph node area”
Stage 1
Describe stage II Hodgkin’s disease
Indicates disease involving two or more lymph nodal areas confined to one side of the diaphragm
Which stage of Hodgkin’s disease is this
“Indicates disease involving two or more lymph nodal areas confined to one side of the diaphragm “
Stage II Hodgkins
Describe stage III Hodgkin’s disease
Disease involving lymph nodes above and below the diaphragm
Which stage of Hodgkin’s disease is this
“Disease involving lymph nodes above and below the diaphragm”
Stage III
Describe stage IV Hodgkin’s disease
Indicates involvement outside the lymph node areas and refers to diffuse or disseminated disease in the bone marrow, liver and other extra nodal sites
The Hodgkin’s stage number in all four cases is followed by the letter A or B what do tgese letters indicate
Absence (A) or presence (B) of one or more of the following:
Unexplained fever >38o C
Night sweats
Loss of >10% of body weight within 6 mths
OR
Whether or not constitutional symptoms are present
What are Hodgkin’s patients with lymph node and splenic involvement staged as
IIIs
How is localized Hodgkin’s extranodal extension from a mass of nodes indicated
By subscript E
What is the treatment for Hodgkin’s lymphoma
Radiotherapy
Chemotherapy
Or a combination of both
Patients with Stage I and IIA Hodgkins disease may be cured by what treatment
Radiotherapy alone
Describe combination therapy for Hodgkin’s disease
Allows short courses of chemotherapy to be combined with reduced levels of radiotherapy and the most effective combinations are being assessed in clinical trials
What type of Chemotherapy is used to treat Stage III and Stage IV Hodgkin’s disease
Cyclical chemotherapy
What types and stage sof Hodgkin’s disease is treated by Cyclical Chemotherapy
STAGE III and IV
STAGE I and II pts who have bulky disease/ type B symptoms or relapse
What combination of drugs is used to treat Hodgkin’s disease in Cyclical Chemotherapy
Combination of Adriamycin
Bleomycin
Vinblastine
Dacarbazine
Describe the Reed Sternberg cell
Binucleate Thick nuclear envelope Perinucleolar halo Large eosinophilic nucleoli Abundant amphophilic cytoplasm
What are three Reed Sternberg cell variants
Mononuclear (Hodgkin’s) cell
Lacunar cell
“Popcorn” cell
List six differential diagnosis of Hodgkins disease
Infectious mononucleosis Immunoblastic lymphadenopathy Post vaccination Dilantin hypersensitivity Sinus histiocytosis with massive lymphadenopathy ATL
