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    Hodgkins Lymphoma by Dr. Anum Usman

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    Humar Haider
    The B symptoms include fever > 38 C on 3 consecutive days, drenching night sweats, and unexplained 10% weight loss.

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    Hodgkins Lymphoma by Dr. Anum Usman

    Uploaded by

    Humar Haider
    65 views48 pages
    The B symptoms include fever > 38 C on 3 consecutive days, drenching night sweats, and unexplained 10% weight loss.

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    © © All Rights Reserved

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    PDF, TXT or read online from Scribd

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    The B symptoms include fever > 38 C on 3 consecutive days, drenching night sweats, and unexplained 10% weight loss.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    65 views48 pages

    Hodgkins Lymphoma by Dr. Anum Usman

    Uploaded by

    Humar Haider
    The B symptoms include fever > 38 C on 3 consecutive days, drenching night sweats, and unexplained 10% weight loss.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 48

    Hodgkin

    Lymphoma
    LEARNING OBJECTIVES

    Define Hodgkin lymphoma

    Classify Hodgkin lymphoma

    Describe pathogenesis of Hodgkin lymphoma

    Describe morphology of Reed Sternberg Cell

    Describe morphology of each type of Hodgkin lymphoma

    Enlist clinical features of Hodgkin lymphoma

    Describe staging of Hodgkin lymphoma

    Tabulate the differences between Hodgkin & Non Hodgkin lymphoma


    Theme / Scenario
     A 25 year old lady
    1 month of evening
    rise of temperature,
    night sweats and
    noticed a lump in her
    neck
    On examination
    pallor, generalized
    lymphadenopathy
    Normal Structure LN
    To recognize
    lymph node
    pathology,
    one has to be
    familiar with
    normal lymph
    node
    anatomy
    LN usually not palpable. Sometimes those in the S/M,
    axillary or inguinal regions may be palpable
    in healthy people.

    Lymphadenopathy :
    Nodes that are abnormal in either size, consistency
    or number.

    Lymphadenopathy may be:

    -- Generalized" if lymph nodes are enlarged in two or


    more noncontiguous areas

    --Localized" if only one area is involved.


    Lymphadenopathy
     Infections
     Reactive hyperplasia
     Sarcoidosis
     Metastatic tumors
     Primary Neoplasms---Lymphomas.
    Lymphomas are all malignant
     Non-Hodgkin lymphomas-NHL
     Hodgkin lymphomas- HL
    Lymphoma
     Clonal malignant disorders that are derived
    from lymphoid cells: either precursor or
    mature T-cell or B-cell

     Majority are of B- cell origin

    Divided into 2 main types :


    1. Hodgkin lymphoma
    2. Non – Hodgkin lymphoma
    Hodgkin’s Disease

     It was named after Thomas Hodgkin (1832).


     Dorothy Reed and Carl Sternberg first
    described the malignant cells of Hodgkin’s
    lymphoma called Reed Stenberg cells

     Histologically & clinically a distinct malignant


    disease
     Predominantly, B-cell disease
    RS Cell & Variants
    RS Cell
    Reed–Sternberg
    cells are very large cell
    (15–45 microns) with
    enormous multilobate
    or have bilobed nucleus
    with prominent
    eosinophilic inclusion-
    like nucleoli surrounded
    by clear zone (thus
    resembling an "owl's
    eye" appearance) and
    abundant cytoplasm.
    Hodgkin Lymphoma
     Incidence:
    - 2-4 cases per 100000 population /
    year
    - bimodal age distribution :
    15-30 years and above 55 years
    - male predominance M:F = 1.7:1
    - rare in children younger than 10 years
    Etiology

     The exact cause of Hodgkin lymphoma is not known

     Viruses:
    The Epstein-Barr virus has been implicated as a
    cause of Hodgkin lymphoma. The presence of the
    genome of this virus is seen in 20%-80% of
    Hodgkin lymphoma tumors.
    Clinical features
     Bimodal age distribution :
     young adults ( 15-30 yrs) & elderly (> 55yrs)
    May occur at any age
     M>F
     Lymphadenopathy:
     most often cervical region
     asymmetrical
     non-tender
     elastic character on palpation ( rubbery)
     not adherent to skin
     fluctuate in size
     Contiguous spread via the lymphatic chain
    eg. involvement of abdominal & thoracic
    LNs

     Hepato-splenomegaly
    Clinical Presentation
     Non tender lymph nodes enlargement ( localised )
     neck and supraclavicular area 60-80%
     mediastinal adenopathy 50%
     other ( abdominal, extranodal disease )
     Other symptoms
     fatigue, weakness, pruritus
     cough, chest pain, shortness of breath, vena cava
    syndrome
     abdominal pain, bowel disturbances, ascites
     bone pain
     Constitutional symptoms ( B symptoms )
     Night sweats,
     sustained fever > 38 degree C,
     loss of weight >10% of body weight in 6 months
     Fever sometimes cyclical (‘Pel-Ebstein fever’)
     Pallor
    Classification: REAL/ WHO
     Classic:
     Nodular Sclerosis HL
     Lymhocyte Rich HL
     Mixed Cellularity HL
     Lymhocyte depleted HL

     Non-Classic
     Nodular Lymphocyte predominant (NLPHL)
    MORPHOLOGY of
    HODGKIN LYMPHOMA
    HL : Nodular Sclerosis

     Most common subtype in developed countries


     Accounts for 50-75% of all cases of HL
     Accounts for 40% of younger patients and 70%
    of adolescents with HL
     Often involves lower cervical, supraclavicular,
    and mediastinal nodes
     CD 15 and CD 30 positive; CD 45 Negative
    Lymph node: Nodular sclerosis HL
    HL: NS

    Thickened lymph node


    capsule, organized
    collagenous bands forming
    circumscribed nodules

    Lacunar cells are seen


    HL : NS

    Large single multilobe irregular nuclei with


    multiple small nucleoli,
    cytoplasm retracts when
    fixed with formalin so
    nuclei gives the
    appearance of cells
    that lie in empty spaces
    (lacune).
    Mixed Cellularity HL
     Accounts for 15-30% of all cases of HL
     Common in older people (above 50 years)
     Most frequent subtype in HIV patients
     Frequently presents with advanced disease
    and extranodal extension at diagnosis
    HL : MC

    Many Reed-
    Sternberg cells are
    present

    LN has inflammatory
    background with
    lymphocytes, plasma
    cells, eosinophils,
    histiocytes, and
    malignant reticular
    cells
    HL : MC
    Immuno staining: CD-30
    Lymphocyte Rich - HL
     Uncommon form of HL
     Lymph nodes are diffusely effaced with
    reactive lymphocytes.
     Mononuclear hodgkin cells and classical
    RS cells are present.
     CD15 and CD 30 are positive
     About 40 % are EBV associated.
     Very good to excellent prognosis
    LR - HL
    Lymphocyte Depletion - HL
     Rare in children, predominantly in elderly.
     Many bizarre, malignant reticular cells
     Many RS cells
     Few lymphocytes
     Diffuse fibrosis and necrosis
     Often presents with widespread disease
    with bone and bone marrow involvement
    LD - HL
    Nodular LP HL
     <5% of Hodgkin lymphomas
     Accounts for 10-15% of children with HD
     Often presents as localized disease; cervical,
    axillary or mediastinal
     More common in males (2:1)
     LN structure partially or completely destroyed
     Positive for CD20, CD 45•
    Negative for CD15, CD 30.
    HL: NLP

    Reed-Sternberg cells
    are rare.

    “L&H” cells or
    “Popcorn” cells are
    seen
    (delicate puffy
    nucleus resembling
    popcorn cell)
    Investigations
     CBP :
    Anemia ( normochromic / normocytic),
    eosinophilia, neutrophilia, lymphopenia
     ESR -raised
     LFT- (liver infil / obs at porta hepatis)
     RFT- prior to treatment
     LDH - adverse prognosis
     CXR- mediastinal mass
     CT thorax / abdomen / pelvis-for staging
     Other: Gallium scan, PET, Lymphangiography ,
    Laporotomy
     LN FNAC / biopsy :

     Malignant REED-STERNBERG ( RS) Cell:


    Bi-nucleate cell with a prominent nucleolus.

     Reactive background of eosinophils,


    lymphocytes, plasma cells

     Fibrous tissue
    HL - FNAC
    Staging
     Stage I : Involvement of single LN region (I) or extra
    lymphatic site (IAE )
     Stage II : Two or more LN regions involved (II) or an
    extra lymphatic site and lymph node regions on the
    same side of diaphragm
     Stage III : Involvement of lymph node regions on both
    sides of diaphragm, with (IIIE) or without (III) localized
    extra lymphatic involvement or involvement of the
    spleen (IIS) or both (IISE)
     Stage IV : Involvement outside LN areas (Liver, bone
    marrow)

    A : Absence of ‘B’ symptoms


    B : B symptoms present
    Treatment

     Radiotherapy
     Chemotherapy
     Bone MarrowTransplant / Stem cell
    Transplant
     Antibody treatment: Rituximab target CD-20
     Supportive
    Hodgkin Lymphoma(HL) Non Hodgkin Lymphoma (NHL)
    Dr Thomas Hodgkin---1832
    1 Malignancy of lymphocytes Malignancy of lymphoid cells
    2 Usually lymph nodes Lymph nodes & other organs
    3 Disease of B-lymphocytes Can be B or T Lymphocytes
    4 About 10 % of lymphomas More than 90 % of Lymphomas
    5 Age( 10-20 and more than 50 yrs More than 60 yrs
    6 Homogenous group(5 types) More than 60 types
    7 Painless lymphadenopathy Painless lymphadenopathy in
    usually upper part of body throughout body
    8 Progress in orderly fashion and Diagnosed at advanced stage
    diagnosed at early stage

    9 HL—treatable----5 yr survival Low survival rate (30 – 40 %)


    more than 90 %
    Quiz Time
    B Symptoms

    Viral association

    Diagnostic Cell in HL

    The Most Common Presentation


    The most common presentation
    of Hodgkin’s

    Painless LAD
    Cervical/thoracic
    B symptoms include…
    Fever > 38 C on 3 consecutive days

    *Drenching night sweats

    *Unexplained 10% wt loss

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