Hodgkin's Lymphoma

Question 1

Define:

Answer 1

Malignant proliferations of lymphocytes - diagnosed histopatholologically by the presence of reed- Sternberg cells (binucleate lymphocytes)

Question 2

Aetiology:

Answer 2

Unknown
There is likely to have an environmental trigger
50% associated with EBV

Question 3

Risk factors:

Answer 3

EBV and HIV 
SLE 
Westernisation 
Obesity 
Affected sibling 
Post transplantation

Question 4

Epidemiology:

Answer 4

Bimodal peaking at 20-30yrs and at greater than 50 yrs

More common in males 2:1

Question 5

Symptoms:

Answer 5

Painless enlarging mass - non-tender, rubbery and superficial (mostly in the neck but can also have in the groin and the axilla)
–> Can be painful post alcohol

Mediastinal mass (lymph nodes)- this can lead to symptoms of obstruction

Fever >38 degrees

Night sweats

Weight loss >10% body weight in 6 months

Pruritis

Cough

Dyspnoea

Question 6

Signs:

Answer 6

Non-tender lymphadenopathy

Splenomegaly (may have hepatic involvement)

Cachexia

Skin excoriations

Signs of intrathoracic involvement - pleural effusion and SVC obstructions)

Question 7

Investigations:

Answer 7

FBC - increased WCC, anaemia of chronic disease, increased neutrophils and eosinophils (lymphopenia in advanced disease)

Increased ESR and CRP

Increase LDH

Lymph node biopsy - diagnostic (reed-sternberg cells)

BM aspirate

CXR, CT, PET

Ann arbor staging

Question 8

What is included in the ann arbor staging:

Answer 8

o I = single lymph node region
o II = 2+ lymph node regions on one side of the diaphragm
o III = lymph node regions on both sides of the diaphragm
o IV = extranodal involvement e.g. liver/bone marrow
o Each stage is either A/B +/- subscript A/E
o A = absence of B symptoms except pruritis
o B = presence of B symptoms – worse prognosis
o E = localised extranodal extension
o S = involvement of spleen