Hodgkin's lymphoma

Question 1

definition of Hodgkin’s lymphoma

Answer 1

Lymphomas are neoplasms of lymphoid cells, originating in lymph nodes or other lymphoid tissues.

ie malignant proliferations of lymphocytes

accumulate in LN = lymphadenopathy

can be in peripheral blood or infiltrate organs

Hodgkin’s lymphoma (15% of lymphomas) is diagnosed histopathologically by the presence of Reed–Sternberg cells (a cell of B-lymphoid lineage)

Question 2

aetiology of hodgkin’s lymphoma

Answer 2

unknown

likely env factor in genetically susceptible individual

EBV detected in 50%, but role in pathogenesis unclear

Question 3

epidemiology of Hodgkin’s lymphoma

Answer 3

bimodal age distribution

peaks at 20-30yrs, >50yrs

male

Annual European incidence is 2–5 in 100,000

Question 4

sx of Hodgkin’s lymphoma

Answer 4

painless enlarging, rubbery, mass - usually in neck, sometimes in axilla or groin - size may fluctuate and may become matted

may become painful after alcohol

B symptoms

• fever >38 (if cyclical referred to as Pel–Ebstein fever)
• night sweats
• weight loss >10% body weight in 6mo

pruritis

lethargy

cough or dyspnoea with intrathoracic disease

Question 5

signs of hodgkin’s lymphoma

Answer 5

Non-tender firm rubbery lymphadenopathy: Cervical, axillary or inguinal.

splenomegaly, occasionally hepatomegaly

skin excoriations

cachexia

anaemia

signs of intrathoracic disease (mediastinal lymphadenopathy = mass effect) - pleural effusion, SVC or bronchial obstruction

Question 6

Ix for Hodgkin’s lymphoma

Answer 6

blood FBC

• anaemia of chronic disease
• leucocytosis
• raised neutrophils
• raised eosinophils
• lymphopaenia with advanced disease
• raised ESR, CRP, LFT (LDH and transaminases)
• urate
• Ca

lymph node biopsy

bone marrow aspirate and trephine biopsy - involvement only seen in late disease

imaging - CXR, CT of thorax, abdomen and pelvis, gallium scan, PET scans.

image guided needle biopsy, laparotomy, or mediastinoscopy may be needed

Question 7

Ann Arbor staining for Hodgkin’s lymphoma

Answer 7

influences treatment and prognosis - doen by imaging +- marrow biopsy if B sx or stage 3-4 disease

1. single lymph node region
2. 2/more lymph node regions on 1 side of the diaphragm
3. lymph node regions on both side of diaphragm
4. extranodal involvement - liver and marrow

• A Absence of systemic sx
• B B symptoms
• E localised extranodal extension
• S involvement of spleen

eg stage is 1-Ae

Question 8

histological subtypes of hodgkin’s lymphoma

Answer 8

nodular sclerosing (70%)

mixed cellularity (20%)

lymphocyte predominent (5%)

lymphocyte depleted (5%)

Question 9

Reed-Sternberg cell

Answer 9

pathognomonic of Hodgkin’s lymphoma

large cell with abundant pale cytoplasm and 2 or more oval lobulated nuclei - containing prominaent ‘owl-eye’ eosinophilic nucleoli

can appear as lacunar or ‘popcorn cells’

Question 10

RF for hodgkin’s lymphoma

Answer 10

an affected sibling

EBV

SLE

post-transplantation

Question 11

emergency presentation of Hodgkin’s lymphoma

Answer 11

infection

SVC obstruction - raised JVP

sensation of fullness in the head

dyspnoea

blackouts

facial oedema