Updated: 8/13/2017

Hodgkin Lymphoma

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Questions
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Topic
Snapshot
  • A 15-year-old boy presents with fatigue and masses around his neck. The masses are small, mobile, and do not hurt. A few months ago, he had had an episode of infectious mononucleosis. He is referred for a lymph node biopsy, which comes back with positive Reed-Sternberg cells.
Introduction
  • B-cell malignancy originating in lymphatic system
  • Pathogenesis 
    • 50% of cases associated with EBV infection
    • Reed-Sternberg cells 
      • CD15+ and CD30+
  • Epidemiology
    • bimodal distribution
      • young adulthood
      • > 55 years
    • male > female
  • Types of Hodgkin lymphoma
    • nodular sclerosing
      • most common
    • mixed cellularity
    • lymphocyte-rich & predominant
      • especially in < 35-year-olds but also in older adults
    • lymphocyte-depleted
      • especially in > 60-year-olds
      • other systemic diseases
  • Risk factors
    • infectious mononucleosis with EBV
Presentation
  • Symptoms 
    • constitutional ("B") symptoms
      • fever
      • night sweats
      • weight loss
      • all caused by cytokines released from Reed-Sternberg cells
    • persistent painless lymphadenopathy
  • Physical exam
    • nontender mass of localized, single group of nodes
      • rubbery
      • mobile
      • cervical
      • supraclavicular
      • axillary
Evaluation
  • Imaging for staging
  • Lymph node biopsy
    • Reed-Sternberg cells
      • binucleate or bilobed, “owl-eyed” nuclei
    • mixed cellularity type
      • large inflammatory infiltrate with many eosinophils
    • nodular sclerosing type
      • diffuse band-like fibrosis with lacunar spaces
Differential Diagnosis
  • Non-Hodgkin lymphoma
  • AIDS-related lymphadenopathy
  • Infection
  • Breast cancer
  • Cat-scratch fever
Treatment
  • Based on staging
  • Chemotherapy
  • Radiation
Prognosis, Prevention, and Complications
  • Prognosis
    • > 80% with treatment
      • better than non-Hodgkin lymphoma
      • lymphocyte-predominant = best prognosis
      • lymphocyte-deplete = worst prognosis
      • higher lymphocyte:RS cell ratio = better prognosis
  • Complications
    • SVC syndrome
    • paraneoplastic syndromes
      • calctriol secretion causes hypercalcemia
    • from treatment
      • risk of solid tumors (breast, thyroid, and lung)
      • risk of premature coronary artery disease
      • risk of infection

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Questions (2)

(M1.ON.17.4753) A 52-year-old female presents to her primary care physician complaining of fever, chills, and night sweats. She says that these symptoms have been present for several months but appear to be getting worse. Her past medical history is significant for mild hypertension and pre-diabetes. She has otherwise been healthy and does not currently take any medications. Physical examination reveals supraclavicular lymphadenopathy. A lymph node biopsy is performed and the result is shown in Figure A. Which of the following cell surface markers is most likely found on the prominent abnormal cell seen in the figure?

QID: 108772
FIGURES:
1

CD3

7%

(9/125)

2

CD4

12%

(15/125)

3

CD8

17%

(21/125)

4

CD16

16%

(20/125)

5

CD30

46%

(58/125)

M 2 C

Select Answer to see Preferred Response

(M1.ON.13.6) A 28-year-old male presents to his primary care physician complaining of fever, chills, night sweats, and a "lump" in the middle portion of his neck. A biopsy of the cervical protuberance is taken and shown in Figure A. The large cell shown in the center of Figure A is likely of which of the following origins?

QID: 101316
FIGURES:
1

B-cell

73%

(64/88)

2

T-cell

7%

(6/88)

3

Basophil

2%

(2/88)

4

Metamyelocyte

3%

(3/88)

5

Monocyte

14%

(12/88)

M 2 E

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Evidence (1)
EXPERT COMMENTS (10)
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