recent andvances hodgkins lymphoma

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  • 1. HODGKINS LYMPHOMA RECENT ADVANCES DR SOWJANYA RAKAM post graduate Chair person : DR TRIVENI B ProfessorModerators : DR VIVEKANANDA Associate prof. DR NEELIMA Asst. prof.
  • 2. 1832 first described by Thomas Hodgkins. 2
  • 3. 1865 - Samuel wilks coined the term Hodgkins disease Since the origin of the RS cell is known to be a lymphoid cell , the term Hodgkins lymphoma is preferred over Hodgkins disease. 3
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  • 7. Nodular lymphocyte predominant Hodgkins lymphoma (NLPHL) Neoplastic cells known as LP cells or lymphocyte predominant cells Background small lymphocytes, histiocytes , epithelioid histiocytes, plasma cells Neutrophils and eosinophils are not seen. 7
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  • 9. IHC markers Positive for CD 20 , CD79a,CD75 ,BCL6,CD45 in all cases. EMA in >50% of cases. Ig heavy chains and light chains positive. LP cells ringed by CD 4+, CD 57+, T cells and small B cells. LP cells negative for CD 15 , CD 30. 9
  • 10. CD 20 LMP 1 10
  • 11. Classical HL Mononuclear Hodgkin cells and multinucleated RS cells.(HRS) Background of small lymphocytes, histiocytes, plasma cells , eosinophils , neutrophils , collagen fibres , fibroblasts. 11
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  • 15. IHC markerspositive for CD 30 ( all cases ) CD 15 ( 75- 80% of cases ) Ki 67 Negative for CD45 , CD75 and CD68. EMA weakly positive . 15
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  • 17. IHC MARKER NLPHL CHL OCT-1 ++ --,variable OCT-2 ++ --,variable BOB-1 ++ -- PU 1 ++ -- EMA ++ -- J chains ++ -- PAX 5 ++ ++ LMP -- ++/--
  • 18. NEWER IHC MARKER Fascin positive for RS cells and dendritic cells Negative in lymphoid cells, plama cells, myeloid cells. May be helpful in differentiating between Hodgkins and non Hodgkins lymphoma in difficult cases. 18
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  • 20. Marrow involvement in HL Bone marrow involved in stage 4 disease Diffuse or focal Typical RS cells,mononuclear variants in a cellular background characteristic of HL Foci of fibrosis and atypical cells 20
  • 21. Cytokines in HRS cellsTGF Formation of collagen bandsIL 5 eosinopoiesisG-CSF Myeloid hyperplasiaIL 4 Macrophage activity factor granulomaTNF & Stimulates fibroblast growthInterferon Fever, chillsIL 6 B symptoms , >22pg/ml, survival

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