Hodgkin's lymphoma Flashcards
What investigations would you order to investigate for lymphadenopathy ?HL?
- Excisional lymph node biopsy
- Immunohistochemistry to determine different types of lymphomas
- Flow cytometry
- Fine needle aspirate (RS cells make up 10-15% of the total cell population)
- Autoimmune antibodies (ANA, antiphospholipid antibodies, Anti-SM, Anti-CCP, RA)
- Microbiology
What are the different types of HL (in order of most common to least common)
- Nodular sclerosing lymphoma (RS cells)
- Mixed cellularity (eosinophils)
- Lymphocyte rich
- Lymphocyte depletion
HL vs. NHL
Which lymphoma is more likely to occur in younger population?
Answer: HL
HL vs. NHL
Which lymphoma is more likely to present with constitutional B symptoms?
Answer: HL
RS cells secrete cytokines with polymorphonuclear inflammation and consequently more type B symptoms, (fever, weight loss, night sweats)
Which lymph nodes are HL more associated with?
Neck, supraclavicular, axilla, more axial/superficial LN
HL vs. NHL
Which lymphoma is more likely to be associated with metastases with extranodal involvement?
Answer: NHL
Increased likelihood of anaemia, CNS metastases and extranodal involvements.
What staging system can be used for lymphoma?
Ann-Arbor staging system can be used.
- Stage 1 and 2: on the same side of the the diaphragm (single vs. many)
- Stage 3 and 4: LN involved on both sides of the diaphragm
A: no type B symptoms B: presence of B symptoms from overproduction of cytokines from RS cells X: largest deposit diameter E: extra-nodal involvement S: splenic involvement
What is the importance of staging HL and NHL?
HL is contiguous spread and a more predictable spread, meaning staging has a prognostic value and guide treatment options.
NHL has disseminated pattern of spread. Prognosis can be determined by grade, bone marrow involvement, B symptoms.
How is NHL staged?
NHL is more difficult to stage due to non-contiguous spread (Ann-Arbor staging system will be stage 3 and 4). Histopathology can be used to determine the tumour margins of spread, determine subtype of NHL and determine prognosis.
It will show cell phenotype, morphology and location, cytogenetics.
What is the treatment of HL? (divide into stage 1, 2 and stage 3, 4)
HL stage 1 and 2: only radiotherapy
HL stage 3 and 4: chemotherapy regime due to widespread nature of the disease ABVD therapy (adriamycin, bleomycin, vinblastine, darcarbazine) for 28 days
What is treatment of NHL?
6-8 cycles of R-CHOP chemotherapy (rituximab, cyclophosphamide, hydroxydoxirubicin, vincristine, prednisone)
What is prognosis like for HL?
Good prognosis; 90% 5-year survival rate.
Best prognosis in lymphocyte-rich subtype;
worst prognosis in lymphocyte-depleted subtype.
What is prognosis for NHL?
Poorest prognosis with aggressive NHLs like diffused large B-cell, having 5-year survival rate of 50%.
Describe the anatomy of lymph node.
It is divided into medulla, cortex, primary and secondary lymphoid follicles containing germinal centres. Lymph nodes are contained within a capsule.
It has afferent and efferent lymphatic vessels, with artery and vein to supply the lymphoid follicles.
In terms of lymph node anatomy, where do B cells reside?
B cells originate & mature in the bone marrow and spleen. Active B cells reside in the germinal centres of the primary lymphoid follicles, inactive cells remain in the marginal areas.
