Updated: 8/13/2017

Hodgkin Lymphoma

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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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