Hodgkin's Lymphoma

Question 1

What is the difference between lymphomas and leukamias?

Answer 1

Lymphomas are disorders with malignant proliferation within the lymphatic system as opposed to leukemias which are in the BM

Question 2

Lymphoma is classified as hodgkin’s and non-hodgkin’s lymphoma. There are 2 types of Hodgkin’s lymphoma.

Define Hodgkin’s lymphoma

What are the 2 types?

What % of lymphomas are Hodgkin’s lymphoma?

Answer 2

Haematological malignancy characterised by abnormal B cell proliferation in the lymphatic system

10% of lymphomas are Hodgkin’s
Also M>F like everything else in this chapter (other than anaemia lol)

2 types: Classical (95%) and Nodular HL (NHL) (5%)

Question 3

Abnormal B cell proliferation is characteristic of Hodgkin’s lymphoma. What are these abnormal B cells called?

Are they present in both HL and NHL?

Answer 3

Reed Sternberg cells

No, in NHL there is an atypical variant of the Reed Sternberg cell which is a lymphocyte with a popcorn appearance on histology

Question 4

Is Hodgkin’s lymphoma only a B cell disease?

Answer 4

Yes

Question 5

The pattern of NHL is nodular, what about classical HL?

Answer 5

Classical is Diffuse, interfollicular

Question 6

What cells are involved in Classical HL. Which of those are also seen in NHL

Answer 6

Lymphocytes (also NHL)
histiocytes (also NHL)
Eosinophils
Plasma cells

Question 7

What are background lymphocytes?
In terms of background lymphocytes is B or T cell lymphoma more common?

Answer 7

Background lymphocytes are the reactive cells that are found in the tumour environment surrounding the malignant cell (in this case Reed Sternberg B-Cells). These immune cells are recruited and influenced by the B cell (malignant cell) to create a niche
HL - T>B
NHL - B>T

Remember the disease is just B cells.

Question 8

What CD markers are associated with classical HL? How about NHL?

Answer 8

HL - CD 15 and 30
NHL - CD 20 and 45

Question 9

Is fibrosis common in both HL and NHL?

Answer 9

No only HL, rare in NHL

Question 10

What is the primary pathogen that is a major RF for Hodgkin’s lymphoma?

Does that apply to NHL or only HL?

Answer 10

Only HL and EBV (50% associated)
NHL is almost always -ve for EBV

Question 11

Which major organ is part of the lymphatic system?

Answer 11

Spleen

Question 12

What is the relation between alcohol and HL

Answer 12

Alcohol ingestion leads to bony pain (at sites of bony involvement)

Question 13

State the symptoms of HL that you would like to elicit in a hx

Answer 13

+ always ask about CNS complications

Question 14

How would you describe LN in HL?

What LN are most likely affected?

Answer 14

Non-tender, firm, rubbery.

Cervical and Supraclavicular (80%)
Axillary LN (5%)
Groin (<5%)

Question 15

State the signs associated with HL

Answer 15

Common:
Splenomegaly
Lymphadenopathy
Pemberton’s sign
Excoriations (2 to pruritis)

Uncommon:
Pallor
Jaundice
Ascites
Bony tenderness

Question 16

When I say someone is immunodeficient, what are the possible causes?

Answer 16

Question 17

What are the RF of HL?

Answer 17

Question 18

What is the diagnostic investigation for HL?

what findings would you expect for

Answer 18

LN biopsy examined with light microscopy and immunohistochemistry

HL - Reed Sternberg cells
NHL - Atypical variant of the Reed Sternberg cell which is a lymphocyte with a popcorn appearance on histology

Question 19

Is FDG PET CT used in both NHL and HL or no?

when is it done?

Answer 19

Only HL because FDG activity is poor in NHL.

Done pre-chemo and Ann Arbour staging

Question 20

go through the investigations for Hodgkin’s Lymphoma

Answer 20

Question 21

If a patient presents with CNS symptoms what additional tests will you perform?

Answer 21

LP for CSF cytology
CT/MRI brain

Question 22

What grading scale is used in HL?
What investigation(s) is/are used to determine the classification?
Go through it

Answer 22

Ann-Arbor System based on PET CT FDG
+ Suffixes are given
A = asymptomatic
B = B symptoms present
e.g. Stage 3B is LN on both sides AND
N = Nodal
E = Extranodal
X = Bulky disease

Question 23

What is the management of HL?

Answer 23

Question 24

What is the main specific complication of the ABVD regimen for HL?

Answer 24

Temporary oligospermia and irregular menses for 1-2 years after tx

Question 25

What are the Side effects of radiotherapy?

Answer 25

Hypothyroidism (if over thyroid gand)
Infertility, amenorrhoea, premature menopause (if over gonadal tissue)
In general: IHD, Lung fibrosis

a good way to look at it is dysfunction of an organ
e.g. over salivary gland, decreased salivation => increased dental carries

Question 26

What are the complications of HL (disease only)

what about the treatments?

Answer 26

Treatments:
Radiotherapy:
Hypothyroidism (if over thyroid gand)
Infertility, amenorrhoea, premature menopause (if over gonadal tissue)
In general: IHD, Lung fibrosis

ABVD: Temporary oligospermia and irregular menses for 1-2 years after tx

Chemotherapy:
Febrile neutropenia
Tumour lysis syndrome
Alopecia
Cardiotoxicity
Infertility
Risk for secondary malignancy (e.g. melanoma, breast, thyroid)
Endocrinopathies (impaired glucose and insulin metabolism, thyroid dysfunction