Download Hodgkin`s Disease - American Medical Technologists

365
Article
1 Clock Hour
Hodgkin’s Disease
Gerard P. Boe
Introduction
Hodgkin’s disease is a malignancy that originates
in the lymphatic system. The disorder usually begins
in the lymph nodes or the spleen but can also be present in other areas.
To understand the changes that occur in lymphoma, it is necessary to provide a short look at the
lymphatic system. Lymph is a substance similar to
plasma which circulates through a system of vessels
similar to the blood circulation system. During normal metabolism, a small amount of the fluid portion
of the blood filters out of the capillaries into the surrounding tissues. The lymphatic system helps maintain a balanced internal tissue environment by removing excess fluid as lymph. The fluid is drained
through afferent vessels into small bean-shaped
lymph nodes.
Gerard P. Boe, PhD.,
CLC(AMT),
MT(AMT), Executive
Director of AMTIE,
Editor of Journal of
Continuing Education
Topics & Issues, and
Chair, AMT CLC
Evaluation Committee
Function of the Lymphatic System
The primary function of the lymphatic system is to
provide an immune defense. This complex system can
differentiate between self and foreign molecules (antigens) and is able to recognize antigens it previously
encountered and mount a defense. In addition to these
outside antigens, the lymphatic system is capable of
removing aged and damaged (senescent) cells.
During fetal development, lymphatic precursors
originate first in the fetal liver and later in the bone
marrow. At this time in their development, some of
the cells migrate to the thymus and become T-cells
while those that remain in the liver or bone marrow
become either B-cells or natural killer cells (NK).
The thymus and bone marrow are considered to be
primary lymphoid organs because they are maturation sites for the cells, which move into the secondary
lymphoid organs where they serve to protect the body
against foreign antigens.
An antigen is any substance which the body may
consider to be foreign. They (antigens) may be viruses, tumor cells, bacteria or fungi. The interaction of
the T-cells and B-cells protect the body against these
invaders and is called the immune response.
Lymphatic Alterations in Hodgkin’s
Disease
Changes that occur in this disease can be categorized into three areas — anatomic, histologic and immune function.
Anatomic Changes: The physical changes that
may occur are enlarged spleen and lymph nodes.
When the spleen is involved, it most often indicates
spread through the hematologic system and may also
include the liver and bone marrow.
Histological Changes: There may be a significant
presence of large Reed-Sternberg or Hodgkin’s cells.
There may be a depletion of lymphocytes and an increase in eosinophils. The Reed-Sternberg cells are
binucleated or multinucleated and must be present in
order for the diagnosis of Hodgkin’s disease to be
made.
Immune Function: Cellular immunity is defective in Hodgkin’s lymphoma. Even for several years
after successful treatment, the production and function of the T-cells may be impaired. The abnormalities include a decreased natural killer cell toxicity,
suppressor monocyte activity and possibly delayed
cutaneous hypersensitivity. The function of B-cells
is usually normal in untreated patients with
Hodgkin’s disease.
Signs and Symptoms
The severity of the disease is often proportional to
the number of systems or organs involved. It may be
localized or it may present itself in a number of different systems. Symptoms may appear in any one or
more of the following systems:
Lymphatic System — Many patients have enlarged
lymph nodes. Frequently, the nodes are located in the
cervical and the supraclavicular area but they may
also be seen in the axillary, mediastinal and inguinal
reagions. Pain in the lymph nodes after the ingestion
of alcohol is found in about 10% of patients and can
be said to be specific for Hodgkin’s.
Renal system — Troubles in the renal system are
often a complication of advanced disease. Metabolic
continued pn page 77 (after insert )
76 April 2010 • Continuing Education Topics & Issues
abnormalities, such as abnormal uric acid levels, may
occur.
Bone Marrow — Bone marrow involvement occurs in only about 10% of untreated cases. Bone marrow involvement may demonstrate the following
characterstics: increase in granulocytes, monocytes,
and eosinophils and there may be areas of fibrosis
along with the abnormal infiltration of lymphocytes
and macrophages without the presence of HodgkinReed cells.
Gastrointestinal — Patients may complain of abdominal pain, vomting and nausea. If the spleen or
abdominal lymph nodes are involved, there may be
other vague symptoms and GI bleeding.
Diagnosis and Treatment
Hodgkin's may occur from early childhood to old
age. Increased numbers of cases of some types may
be noted in patients between 15 and 35 and then
again after 50 years of age. Males seem to be more
susceptible than females.
When Hodgkin's disease is suspected, microscopic histological examination of the lymph nodes
through a biopsy helps to classify the Hodgkin's. The
histology of Hodgkin's can vary from patient to patient; it is important to determine the classification
and the treatment as well as the prognosis.
Treatment modalities for individuals with
Hodgkin's disease are based on age, classification and
the overall condition of the patient. One or more of
the following methods may be used:
• Chemotherapy
• Irradiation
• Chemotherapy and irradiation
• Bone marrow transplant
Summary
Lymphomas are malignancies that originate in the
lymphatic system. Usually originating in the lymph
nodes, these disorders can infiltrate in areas such as
lungs, bone, testes and brain.
Hodgkin's disease is one of the two major categories of lymphomas.
The thymus and bone marrow are categorized as
primary lymphoid organs because they function as
differentiation and maturation sites. The lymphoid organs serve as sites where lymphocytes protect the
body against antigens. The interaction of T and B
cells to protect the body from the "foreign invaders"
(antigens) is called the immune response.
The cause or causes of Hodgkin’s have not been
identified. Some researchers have voiced the opinion
that it is heterogeneous and possibly represents more
than one disease.
References
Devita, Jr., Vincent T., et. al., Cancer:Principles and Practice of
Oncology, 5th ed, 2001
Beutler, Ernest, et al, Williams Hematology 6th ed, 2001
Levine, Sandra M., and Mochamuk, Robert S., MD, Hodgkin's
Disease: Reducing Treatment Toxicity and Secondary Malignancies, Annual Meeting of American Society of Clinical
Oncology, May 2001.
Ballanti, Joseph A. ed., Clinical Immunology, W.B Saunders Co.,
Philadelphia, 1994
Continuing Education Topics & Issues • April 2010 77
365
Article
1 Clock Hour
Questions for STEP Participants
You can submit your answers either online or manually. To submit your answers online, go to www.amt1.com, click on AMT Store on
the top navigation bar. Click on STEP Online, then select the article number and purchase the relevant test (member fee is $3/online test, no
cost for download of article — don't forget to login with your member ID to receive the discounted $3 online test fee; nonmember fee is $5
for download of article, $10 for online test).
If you wish to submit answers manually (only available to AMT members — member fee is $6/manual test), please submit answers
on official AMT answer sheets only. Request answer sheets by email: [email protected]; by fax: 847-823-0458; or by mail:
STEP Program Answer Sheets, American Medical Technologists, 10700 W. Higgins Road, Suite 150, Rosemont, IL 60018. When submitting answers manually, please be sure to include all the required information on the answer sheet and the $6 processing fee per article.
In the following, choose the one best answer for each question.
1
Lymph is similar in composition to:
A. blood
B. plasma
C. spinal fluid
D. pleural fluid
2
Which of the following are primary lymphoid
organs?
1. bone marrow
2. lymph nodes
3. thymus
4. tonsils
A. 1, 2, 3
B. 1 and 3
C. 2 and 4
D. 4 only
3
In Hodgkin’s, metabolic disorders may occur
and produce abnormal levels of uric acid.
A. True
B. False
4
Females seem to be more susceptible to
Hodgkin’s disease than males.
A. True
B. False
5
In addition to providing antimmune response,
the lymphatic system removes senescent cells.
A. True
B. False
78 April 2010 • Continuing Education Topics & Issues
6
At the time of their maturation, some cells
move to the thymus and become T-cells.
A. True
B. False
7
In order to make the diagnosis of Hodgkin’s,
multinucleated Reed-Sternberg cells must be
present.
A. True
B. False
8
The lymphatic system helps maintain a
balanced internal tissue environment by
removing excess fluid.
A. True
B. False
9
Anatomic changes in Hodgkin’s may be in the
form of an enlarged spleen and lymph nodes.
A. True
B. False
10
Cellular immunity is defective in Hodgkin’s.
A. True
B. False