Hodgkin lymphoma
Download as PPT, PDF7 likes1,889 views
Hodgkin’s disease, a type of lymphoma arising from B lymphocytes, presents with Reed-Sternberg cells and has a bimodal age distribution. It accounts for approximately 30% of malignant lymphomas, with classical Hodgkin’s making up 95% of cases. Treatment can lead to over 80% cure rates, although long-term effects and prognostic factors such as advanced stage and 'B' symptoms should be considered.
Hodgkin lymphoma
- 3. B cell malignancies Pre-B acute lympho- blastic leukemia B cell lymphoma Chronic lympho- cytic leukemia Multiple myeloma Progressive B lymphocyte maturation Bone marrow Lymph node, lymph, blood, bone marrow Lymph node, lymph, blood, bone marrow Bone marrow Lymphoid stem cell Maturing B cell many stages Mature B cell Plasma cell
- 4. Hodgkin’s Disease/Lymphoma In the Beginning 1798-1866 First described in 1832 by Dr. Thomas Hodgkin Neoplasm of B lymphocytes – large pleomorphic prominent nucleolus in a halo - Hodgkin cells Reed-Sternberg cell – binucleate Hodgkin cell with owl eye appearance Classification: Classical Hodgkin’s Nodular sclerosis – low grade Mixed cellularity Lymphocyte rich classical Lymphocyte depleted. – high grade Nodular lymphocyte-rich Hodgkin’s
- 5. Hodgkin’s Disease/Lymphoma In the Beginning Bimodal age distributionBimodal age distribution first peak between 2first peak between 2ndnd - 3- 3rdrd decade of lifedecade of life second peak between 5second peak between 5thth - 6- 6thth decade of lifedecade of life Male: Female 2:1 in kids, adults almost equal M:FMale: Female 2:1 in kids, adults almost equal M:F Mixed cellularity (MC) Hodgkin’s Disease is moreMixed cellularity (MC) Hodgkin’s Disease is more common at younger agescommon at younger ages More common in immune deficiency patientsMore common in immune deficiency patients
- 6. Hodgkin’s Disease/Lymphoma In the Beginning Accounts for ~ 30% of all malignant lymphomasAccounts for ~ 30% of all malignant lymphomas Composed of two different disease entities:Composed of two different disease entities: Lymphocyte-predominant Hodgkin’s (LPHD), making upLymphocyte-predominant Hodgkin’s (LPHD), making up ~ 5% of cases~ 5% of cases Classical HD, representing ~ 95% of all HDs.Classical HD, representing ~ 95% of all HDs. A common factor of both HD types is that neoplasticA common factor of both HD types is that neoplastic cells constitute only a small minority of the cells incells constitute only a small minority of the cells in the affected tissue, often corresponding to < 2% ofthe affected tissue, often corresponding to < 2% of the total tumorthe total tumor
- 7. Fatal disease with 90% of untreated patients dying within 2 to 3 years With chemotherapy, >80% of patients suffering from HD are cured. Pathogenesis of HD is still largely unknown. HD nearly always arises and disseminates in lymph nodes Hodgkin’s Disease/Lymphoma In the Beginning
- 8. Hodgkin’s Disease/Lymphoma Interest tidbits Pel-Ebstein Fevers Pain with alcohol consumption
- 9. Nontender lymph nodes enlargement (localized)Nontender lymph nodes enlargement (localized) neck and supraclavicular areaneck and supraclavicular area mediastinal adenopathymediastinal adenopathy other (abdominal, extranodal disease)other (abdominal, extranodal disease) systemic symptoms (B symptoms)systemic symptoms (B symptoms) feverfever night sweatsnight sweats unexplained weight loss (10% per 6 months)unexplained weight loss (10% per 6 months) other symptomsother symptoms fatigue, weakness, pruritusfatigue, weakness, pruritus cough , chest pain, shortness of breath, vena cavacough , chest pain, shortness of breath, vena cava syndromesyndrome abdominal pain, bowel disturbances, ascitesabdominal pain, bowel disturbances, ascites bone painbone pain Hodgkin’s Disease/Lymphoma Clinical Presentation
- 10. SIGNS & SYMPTOMS % OF PATIENTS Lymphadenopathy 90 Mediastinal mass 60 “B” symptoms 30 Fever, weight loss, night sweats Hepatosplenomegaly 25 Most commonly involved lymph nodes are the cervical and supraclavicular in 75% Bone marrow is involved in 5% of patients Hodgkin’s Disease/Lymphoma Clinical Presentation
- 13. Hodgkin’s Disease/Lymphoma Clinical Presentation Stage Definition I Involvement of a single lymph node region (I) or of a single extralymphatic organ or site (IE) II Involvement of two or more lymph node regions on the same side of the diaphragm (II) or localized involvement of an extralymphatic organ or site and one or more lymph node regions on the same side of the diaphragm (IIE) III Involvement of lymph node regions on both sides of the diaphragm (III) which may be accompanied by involvement of the spleen (IIIS) or by localized involvement of an extralymphatic organ or site (IIIE) or both (IIISE) IV Diffuse or disseminated involvement of one or more extra lymphatic organs or tissues with or without associated lymph node involvement B symptoms: fever > 38ºC for three consecutive days, drenching night sweats or unexplained loss 10% or more of weight the preceding 6 months
- 14. Hodgkin’s Disease/Lymphoma Treatment Unfavorable prognostic factors:Unfavorable prognostic factors: - Stage IIIB, IV- Stage IIIB, IV - B symptoms- B symptoms - Bulky disease- Bulky disease - High ESR >50- High ESR >50
- 15. Long term effects of treatment should beLong term effects of treatment should be taken into consideration:taken into consideration: - Treatment-related second neoplasms- Treatment-related second neoplasms (i.e. AML, NHL and breast cancer)(i.e. AML, NHL and breast cancer) - Infertility- Infertility - Growth consideration- Growth consideration - Long-term organ dysfunction (i.e.,- Long-term organ dysfunction (i.e., thyroid, heart, lung)thyroid, heart, lung) Hodgkin’s Disease/Lymphoma Treatment
- 16. Adolescent patients who have achieved maximum growth can be treated as adult patients Chemotherapy alone protocols for localized disease has been used in developing countries with some success Hodgkin’s Disease/Lymphoma Treatment Lobo-Sanahuja F: Medical and Pediatric Oncology 22(6);1994