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Updated: Aug 13 2017

Hodgkin Lymphoma

4.8

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(12)

  • 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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