Hodgkin's lymphoma

Question 1

At what age does Hodgkin’s generally arise?

Answer 1

Age-related, bi-modal incidence:
· First peak at approximately 25 years.
· Second peak after age 50-60 years.

Question 2

What is the pathophysiology of Hodgkin’s?

Answer 2

· Different in patients with EBV-positive and EBV-negative HL.

· A B-cell malignancy.

· EBV positive disease:

• Viral proteins allow infected, abnormal B cells to evade apoptosis and replicate in an uncontrolled manner.
• Mixed cellular histology.

Question 3

Define Hodgkin’s.

Answer 3

Uncommon haematological malignancy arising from mature B cells.

Question 4

What staging system is used in Hodgkin’s?

Answer 4

Ann Arbor staging system.

Question 5

What is the aetiology of Hodgkin’s?

Answer 5

· Unclear aetiology, but likely multi-factorial.
· Varies with age, geography and histological sub-type.
· Reed-Sternberg cells harbour EBV in a significant proportion of cases.
· There’s also a genetic pre-disposition associated with it too.

Question 6

List the potential risk factors.

Answer 6

· Hx of EBV infection, including glandular fever.
· FHx of HL.
· Young adults from higher socio-economic class.
· Jewish ancestry.

Question 7

What are the signs and symptoms for lymphadenopathy?

Answer 7

· Painless.
· Most commonly involving the cervical and/or supraclavicular nodal chain.
· Mediastinal adenopathy is common but often asymptomatic.

Question 8

What are the B symptoms?

Answer 8

· Unexplained fevers.
· Night sweats.
· Weight loss.

Question 9

What are the signs and symptoms for mediastinal adenopathy (if extensive)?

Answer 9

· Dyspnoea.
· Dry cough.
· Chest pain.
· SVC syndrome - dyspnoea, cough, orthopnoea, facial/upper extremity oedema and dilated neck veins.

Question 10

What other signs and symptoms can occur?

Answer 10

· Generalised pruritis.
· Pain at sights of lymphadenopathy after drinking alcohol - distinct for HL.
· Hepatomegaly/Splenomegaly.

Question 11

List some potential differentials.

Answer 11

· Non-Hodgkin’s lymphoma.
· Lymphadenopathy from other malignancies.
· Glandular fever.
· Reactive lymph nodes.

Question 12

What differentiates Hodgkin’s from Non-Hodgkin’s?

Answer 12

· HL tends to spread from one lymph node chain to another.

· Involvement of Waldeyer ring and extra-nodal sites is common with NHL.

· HL patient’s tend to be younger.

· Pathological confirmation is the only method to distinguish between the two.

Question 13

What is the treatment option for Hodgkin’s?

Answer 13

Chemotherapy +/- radiotherapy.

Question 14

What complications may arise?

Answer 14

· Radiotherapy-related thyroid abnormalities.
· Chemotherapy and radiotherapy-related.
· Impaired immunity.