HODGKINS LYMPHOMA

HODGKINS LYMPHOMA

DefinitionNeoplastic disorder of lymphoid tissue REED-STERNBERG CELLS in the appropriate cellular background of the involved tissue

Whats the difference between NHL & HL???

Hodgkins LymphomaNon Hodgkins LymhomaLocalized to single axial gp of LNsMultiple peripheral LNs involvedContiguous spreadNon contiguous spreadMesenteric nodes & Waldeyer ring rarely involvedMesenteric nodes & Waldeyer ring commonly involved

Extra nodal presentation rareExtra nodal presentation common

DifferencesBimodal age presentation

Risk factors Epstein barr virus HIV infection

Almost always begins in the lymph nodesCervical and supraclavicular 70-75%Axillary and mediastinal 5-10%Abdominal and inguinal 90% of tumour cellularityReed-Sternberg (RS) Cell Reed-Sternberg (RS) Cell

Reed-Sternberg (RS) Cell

Large cell

Multiple nuclei or single nucleus with multiple nuclear lobes

Large inclusion like nucleolus

Cytoplasm-adundantReed-Sternberg (RS) Cell

Mononuclear variant single nucleus with large inclusion like nucleolusVariants of RS Cell

Lacunar cell Delicate, folded or multilobed nucleiAbundant pale cytoplasm

Variants of RS Cell

Lymphohistiocytic variant (L&H cells)Aka Popcorn cellsPolypoid nucleusInconspicuous nucleoliVariants of RS Cell

15Mummified Cells Cell shrinks & becomes pyknotic Variants of RS Cell

MC 65-70%Adolescents & young adults F>MLN, Spleen , liver, marrow, mediastinumLacunar variantBands of collagen dividing LN into circumscribed nodulesCD15 & 30 PositivePrognosis - ExcellentNodular SclerosisNodular Sclerosis

20-25%Older patients M>FSystemic symptoms +EBV +Classic & Mononuclear variantHeterogenous cellular infiltrate T cells, eosinophils, macrophages, plasma cellsCD15 & 30 PositivePrognosis - GoodMixed CellularityMixed Cellularity

Uncommon Older patients M>FEBV +Reactive lymphocytes Majority populationCD15 & 30 PositivePrognosis Good to excellent Lymphocyte-Rich Least common FIn HIV+ individualsEBV +Systemic symptoms +Paucity of lymphocytes, abundance of RS cellsCD15 & 30 PositivePrognosis Less favourableLymphocyte Depletion Lymphocyte Depletion

Lymphocyte Predominance Uncommon 5%Young malesCervical & axillary LADL&H cellsNumerous reactive B cells & follicular dendritic cellsCD15 & 30 NegativeCD20 Positive Prognosis - ExcellentLymphocyte Predominance

Staging

Blood investigations: CBC, PS, ESR, LFT, KFT, LDH, Urate , Ca

Lymph node biopsy

Chest X-ray, CT of thorax, abdominal, pelvis and bone marrow biopsystaging of HLDiagnosisChemotherapy - ABVD

RadiotherapyTreatmentStage I & IIA 5yr survival rate 90%

Stage IIIB & IV 5yr survival rate 60-70%

Prognosis