Lymphoma (Hodgkin's)

Question 1

Definition

Answer 1

Lymphomas are neoplasms of lymphoid cells, originating in the lymph nodes or other lymphoid tissues. Hodgkin’s lymphoma (15% of all lymphomas) is diagnosed histopathologically by the presence of Reed-Sternberg Cells (binucleate lymphocytes)

Question 2

Aetiology/risk factors

Answer 2

· UNKNOWN
· Likely to be an environmental trigger in a genetically susceptible individual
· EBV genome has been detected in 50% of Hodgkin’s lymphomas

Question 3

Epidemiology

Answer 3

· Bimodal age distribution with peaks at 20-30 yrs and > 50 yrs
· More common in MALES

Question 4

Presenting symptoms

Answer 4

· Painless enlarging mass
o Most commonly in the neck
o Can also be in the axilla or groin
· The mass may become painful after alcohol ingestion

· B symptoms of Lymphoma
o Fever > 38 degrees
· If this is cyclical it is referred to as Pel-Ebstein fever
o Night sweats
o Weight loss > 10% body weight in the past 6 months

· Other symptoms
o Pruritis
o Cough
o Dyspnoea

Question 5

Signs on physical examination

Answer 5

· Non-tender firm rubbery lymphadenopathy (may be cervical, axillary or inguinal)

· Splenomegaly (or sometimes, hepatosplenomegaly)

· Skin excoriations

· Signs of intrathoracic disease (e.g. pleural effusion, superior vena cava obstruction)

Question 6

Investigations

Answer 6

· Bloods
o FBC:
· Anaemia of chronic disease
· Leucocytosis
· High neutrophils
· High eosinophils
· Lymphopaenia in advanced disease
o High ESR and CRP

· Lymph Node Biopsy

· Bone Marrow Aspirate and Trephine Biopsy

· Imaging - CXR, CT, PET

Question 7

Ann Arbor Staging

Answer 7

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

o A = absence of B symptoms
o B = presence of B symptoms
o E = localised extranodal extension
o S = involvement of spleen