Post on 16-Apr-2017
Embed Size (px)
definitionHodgkin's lymphoma is a chronic ( in rare case acute) disease ,the growth of the tumor cells take place mainly in the lymphatic node.Hodgkin's lymphoma, previously known as Hodgkin's disease, is a type of lymphoma, which is a type of cancer originating from white blood cells called lymphocytes. It was named after Thomas Hodgkin, who first described abnormalities in the lymph system in 1832 As Hodgkin's lymphoma progresses, it compromises your body's ability to fight infection.
Hodgkins lymphoma has been subdivided into two main categories:
1) Nodular Lymphocyte-predominant Hodgkins Lymphoma (NLPHL)
It is no longer classified as a form of classic Hodgkin's lymphoma (HL). This is because the Reed-Sternberg Cell (RSC) variants (popcorn cells) that characterize this form of the disease invariably express B lymphocyte markers such as CD20 (thus making NLPHL an unusual form of B cell lymphoma), and that (unlike classic HL) NLPHL may progress to diffuse large B cell lymphoma. 2) Classical Hodgkins Lymphoma.
Sign and symptomsNight SweatsUnexplained weight lossLymph nodes: the most common symptom of Hodgkin's is the painless enlargement of one or more lymph nodes. The nodes may also feel rubbery and swollen when examinedSplenomegaly: enlargement of the spleen occurs in about 30% of people with Hodgkin's lymphomaHepatomegaly: enlargement of the liver, due to liver involvement, is present in about 5% of cases.Hepatosplenomegaly: the enlargement of both the liver and spleen caused by the same disease.PainRed-coloured patches on the skin, easy bleeding and petechiae due to low platelet countCoughing, trouble breathing or chest painLoss of appetiteItchingIncreased sensitivity to the effects of alcohol or pain in your lymph nodes after drinking alcohol
causesThe exact cause of Hodgkin's lymphoma is unknown.Hodgkin's lymphoma commonly begins in lymph nodes located in the upper part of your body. Some lymph nodes are in areas more readily noticed, such as in your neck, above your collarbone, under your arms or in your groin area. Enlarged lymph nodes in the chest cavity also are common. Eventually, Hodgkin's lymphoma may spread outside your lymph nodes to virtually any part of your body.A key step in Hodgkin's lymphoma involves the development of abnormal B cells.
Abnormal B-cellB cells are a type of lymph cell that's an important part of your immune system's response to foreign invaders. B cells normally work with T cells, which mature in the thymus, to fight infection.When B cells develop into large abnormal cells, these abnormal, cancerous cells are called Reed-Sternberg cells. Instead of undergoing the normal cell cycle of life and death, Reed-Sternberg cells don't die, and they continue to produce abnormal B cells in a malignant process. These cells also attract other normal immune cells that cause the lymph nodes to enlarge.
in isolated lymphogranulomatosis, one group of lymphatic node are involved( cervical,mediastinal,retroperitoneal)General
the growth of tumour cells occurs not only in the primary focus but also far fron it. As a rule the spleen is involved.Its pulp is red with numerous white yellow foci of necrosis and sclerosis, so called diffuse waxy spleenThe process become generalized due to metastasis from primary node.
Clinico morphologyVariant 1: with prevail of lymphoid tissue( lymphohistocyte)Variant 2: nodular sclerosisVariant 3: mixed-cell variantVariant 4: with inhibition of lymphoid tissue
macroscopyAffected lymph nodes (most often, laterocervical lymph nodes) are enlarged, but their shape is preserved because the capsule is not invaded. Usually, the cut surface is white-grey and uniform; in some histological subtypes (e.g. nodular sclerosis) a nodular aspect may appear.
A fibrin ring granuloma may be seen.
Microscopy studyMicroscopic examination of the lymph node biopsy reveals complete or partial effacement of the lymph node architecture by scattered large malignant cells known as Reed-Sternberg cells (RSC) (typical and variants) admixed within a reactive cell infiltrate composed of variable proportions of lymphocytes, histiocytes, eosinophils, and plasma cells. The Reed-Sternberg cells are identified as large often bi-nucleated cells with prominent nucleoli and an unusual immunophenotype. In approximately 50% of cases, the Reed-Sternberg cells are infected by the Epstein-Barr virus.Demonstrate proliferation of lymphocytes, histiocytes, reticulocytes, eosinophiles,plasmoblasts and plasmocytes,neutrophilesThese cell form accumulation of the nodes with necrotic and sclerotic changes.Atypical cell (small hogdkin's cells, mononuclear giant cells or large hogdkin's cells) are revealed.
ComplicationRenal amyloidosis followed by contracted kidney and uremiaIntoxicationSeptic complicationCardiovascular diseaseSecond malignancy, such as leukemia, non-Hodgkin's lymphoma and tumors in the lungs, breasts or gastrointestinal systemVascular disease, including strokeThyroid dysfunctionSterilityDeath
People with hodgkin's lymphoma
Chronic hodgkin's lymphomaThe glands are usually larger than in tuberculosis, and they remain longer discrete and movable; they are firm in consistence, and on section present a granular appearance due to overgrowth of the connective-tissue framework.
Hodgkin's disease(at neck and axillary)Lymphadenoma (Hodgkin's Disease) affecting left side of neck and left axilla, in a woman at 44. Three years' duration.
Classical Hodgkin's Lymphoma : Nodular Sclerosis(1)Classical Hodgkins Lymphoma, Nodular Sclerosis: The lymph node is massively enlarged and has a nodular appearance due to bands of fibrosis.
Classical Hodgkin's Lymphoma : Nodular Sclerosis(2)Classical Hodgkins Lymphoma, Nodular Sclerosis: In more advanced cases of Hodgkins Lymphoma, several lymph nodes from the same group may become matted together, as seen in this group of mediastinal lymph nodes. Note the anthracotic pigment in some lymph nodes. The specimen measured 12 cm. in greatest dimension
Hodgkin's disease at liver.Hodgkin's disease (lymphoma) is a malignant cancer that can affect many organs. A whitish, irregular tumor mass of lymphoma cells is seen on the left side of this cross-section of the liver.
Primary Hodgkins lymphoma of spleen78 y/o man with hepatosplenomegaly. Splenectomy specimen showed scattered gray-white nodules. The tumor cells were positive for CD15, CD30, CD20 (partial) and negative for CD45. Spleen is the most common extranodal site of involvement in Hodgkins lymphoma. Primary Hodgkins lymphoma of spleen is rare.
Spleens involved by Hodgkins lymphoma(show a single or a few large nodules)Spleens involved by Hodgkins lymphoma may show a single or a few large nodules (shown here) or multiple smaller nodules with a miliary distribution (previous image). Sometimes, small nodules may be inconspicuous and require meticulous sectioning
Nodular Sclerosis type(in lymph node)In Classical Hodgkins Lymphoma, Nodular Sclerosis type, broad collagen bands separate the lymphoid tissue into nodules
Classical Hodgkin's Lymphoma : Nodular Sclerosis (Reed-Sternberg Cells)-lymph nodeThe conventional definition of Hodgkins lymphoma requires the presence of Reed-Sternberg cells (many are seen in this image) in a characteristic background infiltrate composed of eosinophils, lymphocytes, plasma cells, and histiocytes. It lacks the monomorphic appearance of non-Hodgkins lymphomas
Classical Hodgkin's Lymphoma : Nodular Sclerosis (Syncytial variant)In some cases of Classical Hodgkins Lymphoma, Nodular Sclerosis type, the lacunar cells form cohesive sheets (seen here as lighter staining areas in lymphoid nodules. Such cases have been referred to as syncytial variant. When this feature is pronounced, these cases may be mistakenly diagnosed as non-Hodgkins lymphoma, metastatic carcinoma, or even thymoma
Classical Hodgkin's Lymphoma : Lymphocyte DepletedA Reed-Sternberg cell is seen in a background of eosinophils, lymphocytes, and macrophages. Lymphocyte-depleted is the most aggressive type of Hodgkins lymphoma, commonly associated with advanced stages at presentation
Mixed CellularityHigh-power view showing numerous Reed-Sternberg cells in this case of Classical Hodgkins Lymphoma, Mixed Cellularity typeMixed Cellularity type accounts for 20% to 25% of cases of Classical Hodgkins Lymphoma. Reed-Sternberg cells are present in a background of eosinophils, plasma cells, lymphocytes, and atypical mononuclear cells. Fibrosis is usually absent.
Nodular Lymphocyte-Predominant Hodgkin's LymphomaIn Nodular Lymphocyte-predominant Hodgkins Lymphoma, classic Reed-Sternberg cells, eosinophils, plasma cells, and areas of fibrosis are absent. Instead, numerous L&H cells with multilobed, folded nucleus with small nucleoli are present in a background rich in lymphocytes.
Nodular Lymphocyte-Predominant Hodgkin's LymphomaA close-up of L&H cell (popcorn cell) in a case of Nodular Lymphocyte-predominant Hodgkins Lymphoma. It has a large, multilobed, folded nucleus and is surrounded by small lymphocytes. L&H cells are of B-cell lineage and express pan-B-cell markers*(L&H(lymphocyte and histiocytic)
Reed-Sternberg cells(higher magnification-in spleen)Higher magnification view shows Reed-Sternberg cells with inclusion-like macronucleoli and abundant cytoplasm, surrounded by lymphocytes, macrophages, and occasional eosinophil.
Micrograph of hodgkin's lymphoma
The micrograph shows a mixture of cells common in hodgkin's lymphoma