Lymphoma - Hodgkin

Question 1

Definition of lymphoma

Answer 1

Lymphoproliferative disorder which can be divided into Hodgkin and Non-Hodgkin Lymphoma.

Question 2

Epidemiology + Risk factors

Answer 2

15-35 years or +60
EBV infection
HIV infection
Family history

Question 3

Pathophysiology

Answer 3

Characterised by Reed-Sternberg cells (owl-eyes)
Classical HL: (subtypes)
- nodular sclerosis = neoplastic cells surrounded by collagen forming nodules
- mixed cellularity = neoplastic cells surrounded by different cells, neut, eos, lymph, plasma cells + linked to EBV infection
- lymphocyte rich
- lymphocyte depleted
Non-Classical = nodular lymphocyte predominant - characterised by reed-Sternberg cells which have lobulated nucleus + look like POPCORN CELLS

Question 4

Signs

Answer 4

PAINLESS LYMPHADENOPATHY
- hard
- rubbery
- fixed
- contiguous spread unlike NHL
Splenomegaly

Question 5

Symptoms

Answer 5

Systemic B symptoms:
- Fever
-Weight loss
- Night sweats
Pel-Ebstein fever: intermittant fever every few weeks
Alcohol induced lymph node pain
Pruritus
Dyspnoea

Question 6

Investigations

Answer 6

High LDH, ESR
Low Hb
GOLD STANDARD = Lymph node biopsy - reed sternberg cells
STAGING = Ann Harbor
- A = non systemic B symptoms (other than pruitus)
- B = present of B symptoms
1. Single lymph node
2. 2 + lymph nodes on same side of diaphragm
3. lymph nodes on both sides of diaphragm
4. extra nodal organ spread

Question 7

Treatment

Answer 7

ABVD
ADRIAMYCIN
BLEAMYCIN
VINBLASTINE
DACARBAIZINE
SE = alopecia, n+v, myelosuppression (BM failure), INFECTION

Question 8

Complications

Answer 8

FEBRILE NEUTROPENIA
- massive risk in patients with high dose chemo
= fever. tachycardia, sweats, rigors, tachypnoea
= immeadiate broad spec Abx = IV PIPERCILLIN + TAZOBACTAM = BETA LACTAM