Haematology & Oncology >
Hodgkin’s Lymphoma

“Disorder caused by neoplastic proliferation of lymphocytes, characterised by Reed-Sternberg cells (large mononuclear neoplastic cells that fuse – “owl eye” appearance)

Risk Factors
  • Bimodal age groups (young adult, >55)
  • Obese
  • SLE
  • Male
  • Previous Epstein-Barre virus
  • Affected sibling
  • Westernization
  • Post-transplantation
Pathophysiology
  • There are two main types of Hodgkin’s Lymphoma (HL):
    • Classical HL (cHL):
      • More common (90-95%)
      • Reed-Sternberg cells present
      • Histological subtypes:
        • Nodular Sclerosis HL (inflammatory cells and collage –? Nodules, lacunar cells)
        • Mixed cellularity (prevalent in HIV positive patients, a mixture of eosinophils, neutrophils, plasma cells, histocytes surrounding Reed-Sternberg cells)
        • Lymphocyte rich
        • Lymphocyte depleted (rarest form, present in HIV positive patients)
      • Nodular lymphocyte-predominant HL (NLPHL):
        • Male > female
        • Characterised by Reed-Sternberg variant known as the “popcorn cell”
        • Slow-growing, highly curable
Clinical Presentation
  • Enlarged, painless, non-tender, “rubbery”, superficial lymph nodes typically cervical but also axillary or inguinal (NB: mediastinal lymph node involvement in Nodular Sclerosis HL
  • Constitutional symptoms: low-grade fever, night sweats, weight loss, pruritus, lethargy
Investigations
  • History, examination
  • Bloods: FBC, film, ESR, LFT, LDH, urate, calcium (NB increase in ESR or decrease in Hb = worst prognosis)
  • CXR (mediastinal widening), CT chest/abdomen/pelive/neck, PET scan, +/- bone marrow biopsy (staging)
  • Lymph node biopsy
  • Staging: Cotswolds modification of Ann Arbour Staging
Management
  • With curative intent
    • Chemotherapy: ABVD (Adriamycin, Bleomycin, Vinblastine, Dacarbazine
    • Radiotherapy
Complications
  • Arise from treatment:
    • Radiotherapy: increased risk of secondary tumours, ischaemic heart disease, hypothyroidism, lung fibrosis
    • Myelosuppression, nausea, alopecia, infection

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