HODGKIN’S LYMPHOMA

DR. SIDDHARTH

INTRODUCTION Characterized by the presence of tumor

giant cell “ Reed-Sternberg cell”. It is classified into five subtypes: 1. Nodular Sclerosis 2. Mixed Cellularity 3. Lymphocyte Rich 4. Lymphocyte Depleted 5. Lymphocyte Predominance

“Reed-Sternberg cell”

DIFFERENCE HODGKIN’ LYMPHOMA NON HODGKIN’S

LYMPHOMAMORE OFTEN LOCALISED IN SINGLE AXIAL GROUP OF LYMPHNODES

MORE FREQUENT INVOLVEMENT OF PERIPHERAL NODES

ORDERLY SPREAD BY CONTIGUITY

NON CONTIGUOUS SPREAD

MESENTRIC LYMPHNODES AND WALDAYER RING RARELY INVOLVED

COMMONLY INVOLVED

EXTRA NODAL INVOLVEMENT UNCOMMON

EXTRA NODAL INVOLVEMENT COMMON

SPREAD

CLINICAL FEATURES PAINLESS ENLARGEMENT OF

LYMPHNODES IS THE COMMON PRESENTING SYMPTOM.

Can be associated with fever (Pel Ebstein Fever) and night sweats in disseminated disease.

Wt loss > 10 % of body wt. A strange paraneoplastic syndrome in HL

is pain in the affected lymphnodes on consumption of alcohol.

UNUSUAL MANIFESTATIONS Severe and unexplained itching Cutaneous disorders such as erythema

nodosum and icthyosis form atrophy. Nephrotic syndrome Immune hemolytic anemia and

thrombocytopenia Hypercalcemia Paraneoplastic cerebellar degeneration

NODULAR SCLEROSIS

MIXED CELLULARITY

LYMPHOCYTE RICH

LYMPHOCYE DEPLETED

LYMPHOCYTE PREDOMINANT

MC TYPE OF HL

MC TYPE IN INDIA

ASSOCIATED WITH HIV

INCIDENCE EQUAL IN M & F

M>F M>F M>F M>F

RS CELL VARIANT IS LACUNAR CELL

MAXIMUM NO OF RS CELLS

MONO NUCLEAR RS CELLS

MUMMIFIED, NECROBIOTIC

POPCORN CELLS

CD 15+, CD 30+

CD 15+, CD 30+

CD 15+, CD 30+

CD 15+, CD 30+

CD 20 +, BCL 6+ & EMA +

NOT ASSOCIAT WITH EBV

ASSOCIATED WITH EBV NOT ASSOCIAT WITH EBV

EXCELLENT PROGNOSIS

PROGNOSIS VERY GOOD

GOOD POOR PROGNOSIS

EXCELLENT PROGNOSIS

ADOLESCENT & YOUNG ADULT

BIPHASIC INCIDENCE

OLD AGE OLD AGE YOUNG MALES

MORPHOLOGY

INVESTIGATIONS CBC- ANEMIA, EOSINOPHILIA,

NEUTROPHILIA ESR- RAISED LDH LFT AND RFT PRIOR TO RX CHEST RADIOGRAPH – MEDIASTINAL

MASS CT SCAN OF CHEST,ABDOMEN,PELVIS

FOR STAGING BONE MARROW BIOPSY

Ann Arbor staging

TREATMENT Patients with localised disease are cured

90% of time. In patients with good prognostic factors,

extended field radiotherapy has a high cure rate.

Patients with more extensive disease or those with B symptoms receive a complete course of chemotherapy.

Cont…. Chemotherapy regimens used in

hodgkins disease ABVD REGIMEN

MOPP REGIMEN

A- ADRIYAMYCIN M- MECHLORETHAMINE

B- BLEOMYCIN O- VINCRISTINE

V- VINBLASTINE P- PROCARBAZINE

D- DACARBAZINEP- PREDNISONE

Today in US most patients receive ABVD but a weekly chemotherapy regimen administered for 12 weeks called stanford V is becoming increasingly popular.

Patients who relapse after primary chemotherapy can frequently still be cured.

The most serious late side effects include:

1. Acute leukemias 2. Second malignancies- Lung, Breast 3. Coronary artery disease 4. Hypothyroidism 5. Lhermittes’s syndrome 6. Infertility

DD OF A LN BIOPSY SUSPICIOUS FER HODGKIN’S DISEASE

INFECTIOUS MONONUCLEOSIS NON HODGKINS LYMPHOMA PHENYTOIN INDUCED ADENOPATHY NON LYMPHOMATOUS MALIGNANCIES

THANK YOU