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CHAPTER IV

DISCUSSION

At this case, The man (patient) worked as a worker in a factory. We

associated his job with seriousness of this disease because he might work in toxic

environment in the factory that derived from factory waste. As we now that factory

environment is one of the place that have higher risk in toxical exposure. factory

environment, have so many waste like chemical substance and smoke. Toxic

exposure may cause some disease, one of the diseases is Non-infectious diseases,

commonly known as non-communicable diseases, abbreviated as NCDs, non-

infectious diseases are those that are caused by factors such as genetics, environment,

and lifestyle, and not by disease-causing organisms (Badni et al.,2011). This toxic

environment may trigger the development of disease. As foreign substances get into

the body, it can affect the cells and change its normal arrangement. Hence, the toxic

may exaggerate the disease.

In industrialized countries the onset of HL shows a bimodal distribution with

a first peak in the third decade and a second peak after the age of 50. Men are

affected by HL slightly more often than women among all subtypes. This is suitable

with the case which state that the patient is a 62-years old male. In industrialized

countries, young children are only rarely affected by HL in contrast with young adults

where incidence increases with age (Thomas et al., 2002).

The patients physical condition also became worse in the last one month. His

weight decreased up to 10 kilograms because of swallowing disturbance. The patient

lost his appetite, felt nausea, and also looked pale. This is matched with clinical

features of Hodgkins lymphoma, that havepainless swelling (enlargement) of one or

more lymph nodes in early disease. (Walter, 2013).

Beside the painless swelling, we also conclude it because there are matched

feature below :

Fever Persistent fatigue

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Persistent cough and shortness of breath (if HL is located in the chest) Sweating, especially at night (drenching sweats of the whole body, not

just the neck area or chest area)

Weight loss without trying (at least 10% of body weight over 6months)

Enlarged spleen (Armitage, 2010)We suppose that his swallowing disturbance results from the bumps which

spread from one to other lymph nodes around neck area.

Hodgkin lymphoma is characterized by the presence of an abnormal tumor

cell (Reed-Sternberg cell) thought to result from malignant transformation of a B

lymphocyte. Hodgkin lymphoma usually starts in a single lymph node in the upperbody (supraclavicular, axillary, inguinal, or retroperitoneal) and then spreads to the

adjacent nodes progressing in a systematic manner from the original node to the next

in the chain. Advanced Hodgkins lymphoma can spread to any organ of the body,

but the spleen, bone marrow, lungs, digestive tract, and liver are the most common

sites. As the disease progresses, the individual becomes highly susceptible to

infections because of the immune system dysfunction. Increasing numbers of cancer

cells that block the normal function of organs, eventually causing them to shut down

and resulting in death (DeLong & Burkhart, 2013).

Histopathological examinations showed the stroma consists of fibrovascular

and lymphoid tissues. In several sites, there was presence of Reed-Sternberg cells.

We can classify this case into Classical Hodgkins Lymphoma (CHL) since typical

Hodgkins and Reed-Sternberg (H&RS) cells can be easily detected. Neoplasm mass

with increasing of hyperchromatic lymphocytes and various-sized atypical cells were

also found.

Hodgkins lymphoma may involve the lymph nodes, the thymus or both.

Symptoms and radiological findings are non-specific (Kaddour, 2007). Accurate

staging is the basis for the selection of an appropriate therapeutic approach in patients

with Hodgkin disease (HD) and non-Hodgkin lymphoma (NHL). Staging is necessary

in order to prevent over or under treatment as well as to minimize morbidity related

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to the radio-chemotherapy regimens given. Quality of life during and after treatment

may also be improved when therapy is tailored appropriately (Raanani, 2007).

Curative efforts of Hodgkins lymphoma are chemotherapy, radiation therapy,

and combined modality therapy which is the combination of chemotherapy and

radiation therapy (Hutchings, 2012). Treatment depends on the severity of the disease

and microscopic appearance of the tissues. The most common treatment is a

combination of chemotherapy and radiation therapy. Apart from those treatments

above, other treatments being used are monoclonal antibody therapy, also bone

marrow and stem cell transplants (DeLong & Burkhart, 2013).

DeLong L, Burkhart NW. 2013. General and Oral Pathology for The Dental

Hygienist. 2nd

Edition. Baltimore: Wolters Kluwer Health | Lippincott

Williams & Wilkins. p. 240.