Lymphoma, Hodgkin's

Question 1

Define

Answer 1

DEFINITION: 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

Causes

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

Symptoms

Answer 4

Painless enlarging mass

• Most commonly in the neck
• Can also be in the axilla or groin

The mass may become painful after alcohol ingestion

B symptoms of Lymphoma

Fever > 38 degrees

• If this is cyclical it is referred to as Pel-Ebstein fever
  
  • Night sweats
• Weight loss > 10% body weight in the past 6 months

Other symptoms

• Pruritis
• Cough
• Dyspnoea

Question 5

Signs

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

FBC

• Anaemia of chronic disease
• Leucocytosis
• High neutrophils
• High eosinophils
• Lymphopaenia in advanced disease

High ESR and CRP

Lymph Node Biopsy

Bone Marrow Aspirate and Trephine Biopsy

Imaging - CXR, CT, PET

Ann Arbor Staging

• I = single lymph node region
• II = 2+ lymph node regions on one side of the diaphragm
• III = lymph node regions on both sides of the diaphragm
• IV = extranodal involvement
• A = absence of B symptoms
• B = presence of B symptoms
• E = localised extranodal extension
• S = involvement of spleen