Download Hodgkin`s lymphoma

HODGKIN AND NONHODGKIN LYMPHOMA
Dr. M. Sofi MD; FRCP (London);
FRCPEdin; FRCSEdin
Hodgkin’s Lymphoma
 Hodgkin's lymphoma (HL) is a type of lymphoma,
which is generally believed to result from white
blood cells of the lymphocyte kind.
 About half of cases of Hodgkin's lymphoma are due
to Epstein–Barr virus (EBV)
 Most common primary localizations are cervical (60
80%), mediastinal, and inguinal lymph nodes.
 Hodgkin’s lymphomas disseminate both via
lymphatic vessels or per continuitatem into
lymphatic organs as well as by blood vessels or per
continuitatem into extralymphatic organs.
Hodgkin’s Lymphoma
Epidemiology
• The incidence rate is at 2-3/100,000 per year. The
age peak lies at approx. 32 years.
• Hodgkin lymphoma is one of the most treatable
forms of cancer.
• About 75 percent of people diagnosed with Hodgkin
lymphoma can be cured with treatment.
• Over 90 percent of people live at least 10 years after
treatment.
Classification
WHO classification: There are two main types of
lymphoma
I. Nodular Lymphocyte-predominant Hodgkin’s
lymphoma (NLPHL)
• The NLPHL encompasses almost 5% of all
Hodgkin’s lymphomas.
• As opposed to the classical Hodgkin’s lymphomas
the malignant cells are referred to as L&H
(lymphocytic and histiocytic)
• For therapeutic purposes, nodular lymphocytepredominant HL is managed in the same way as
indolent non-Hodgkin lymphoma
Classification
II. Classical Hodgkin’s Lymphoma (cHL)
• Nodular sclerosing (NSHL)
• Mixed cellularity (MCHL)
• Lymphocyte-rich (LRHL)
• Lymphocyte-depleted (LDHL)
• Not classified
Tumor cells of the classical Hodgkin’s lymphomas are referred to
as Hodgkin and Reed-Sternberg cells (H-RS)
Stage-adapted therapy allows long term cure in more than 80
percent of all patients. Hodgkin’s lymphoma is one of the
oncological diseases with the highest cure rates in adults
Features of Hodgkin lymphoma include:
may
be present (above the
diaphragm in 80% of
patients)
Constitutional symptoms
[>10% of total body
weight]
are
present in 40% of
patients; collectively,
these are known as
is
observed in about 35%
of cases
fever is
observed (high fever for
1-2 wk, followed by an
afebrile period of 1-2
wk)
Features of Hodgkin lymphoma include:
of those
may be present due to a
large mediastinal mass or
lung involvement; rarely,
hemoptysis occurs
, precipitated by
drinking alcohol, occurs in
fewer than 10% of patients
but is specific for Hodgkin
lymphoma
rarely
occur
• May present with
in NSHL has
a strong genetic component
and has often previously been
diagnosed in the family.
Physical Examination
can be seen in: the
(neck) - 60-80%
6-20%
(groin) - 6-20%
(back of
the throat, including the
tonsils) or occipital
(lower rear of the head)
or epitrochlear areas is
infrequently observed
may be
present
may develop in
patients with mediastinal
lymphadenopathy
Differential Diagnoses
• Cytomegalovirus
• Infectious
Mononucleosis
• Non-Hodgkin
Lymphoma
• Systemic Lupus
Erythematosus
•
•
•
•
•
•
Sarcoidosis
Serum Sickness
Small Cell Lung Cancer
Syphilis
Toxoplasmosis
Tuberculosis
Test
Laboratory
analyses
Imaging
Bone-marrow
puncture
Investigations
Comments
• Complete blood cell count, including
leukocyte count with differential
• Erythrocyte sedimentation rate
• LDH, GOT, GPT, AP, Gamma GT, uric acid,
creatinine
• Chest X-rays
• CT scan of the neck (with contrast medium)
• CT scan of the abdomen (with contrast
medium)
• PET scan: Initial staging of Hodgkin
lymphoma
• Aspirate (cytology)
• Biopsy (histology)
Staging according to Ann Arbor Classification
Stage I
A single lymph node area or single extra-nodal site
Stage II
2 or more lymph node areas on the same side of the
diaphragm
Stage III
Lymph node areas on both sides of the diaphragm
Stage IV
Disseminated or multiple involvement of the extranodal organs
Addendum A No B symptoms
Addendum B Presence of B symptoms
Lymphocyte
Hodgkin's lymphoma,
mixed-cellularity type
Reed – Sternberg Cell
H L: Reed-Sternberg cells,
Eosinophils , Plasma cells
Non-Hodgkin lymphomas: is a group of blood cancers that
includes all types of lymphoma except Hodgkin's lymphomas.
Non-Hodgkin lymphomas
(NHLs) are tumors
originating from lymphoid
tissues, mainly of lymph
nodes. These tumors may
result from chromosomal
translocations, infections,
environmental factors,
immunodeficiency states,
and chronic inflammation
Signs and symptoms
• Peripheral adenopathy:
Painless and slowly
progressive; can
spontaneously regress
• Primary extranodal
involvement and B
symptoms:
• Uncommon at presentation;
however, common with
advanced, malignant
transformation or end-stage
disease
• Bone marrow: Frequent
involvement; may be
associated with
cytopenias(s); fatigue
weakness more common in
advanced-stage disease
Non-Hodgkin lymphomas
Signs and symptoms
: Most
patients
have a
more varied clinical
presentation:
: More than
one third of patients; most
common sites are GI/GU
tracts (including Waldeyer
ring), skin, bone marrow,
sinuses, thyroid, CNS
:
within 6 months; in
approximately 30-40% of
patients
Physical Examination
Examination in patients with
may
demonstrate:
lymphomas may
result:
:
Usually in Burkitt lymphoma
: Associated
with cutaneous T-cell
lymphoma
Complications: Disease-related complications include:
(neutropenia,
anemia,thrombocytopenia)
secondary to
thrombocytopenia, DIC
secondary to
neutropenia
or arrhythmias secondary
to cardiac metastases
•
and/or
parenchymal lesions
(lymphocytosis) in
leukemic phase of disease
(SVC)
syndrome secondary to a
large mediastinal tumor
secondary to vertebral
metastases
, in a patient
with GI lymphoma
secondary to tumor
invasion
Testing: Laboratory studies with suspected NHL include:
: May show
•
•
•
•
•
Anemia
Thrombocytopenia
Leukopenia
Pancytopenia
Thrombocytosis
: May
show elevated LDH, LFT
and calcium levels
: Especially in
patients with diffuse large
cell immunoblastic or small
non cleaved histologies
serology: Patients with adult
T-cell leukemia/lymphoma
: In
patients in whom rituximab
therapy is planned
of lymph node,
bone marrow, peripheral
blood
: NHL
associated with monoclonal
gammopathy
Imaging studies for NHL include:
with small
bowel follow-through: In
patients with head and
neck involvement and
those with a GI primary
lesion
of the neck,
chest, abdomen, and pelvis
(CT-CAP)
: For
opposite testis in male
patients with a testicular
primary lesion
: Only in
patients with bone pain,
elevated alkaline
phosphatase, or both
:
Procedures:
: For staging
rather than diagnostic
purposes
(extra-nodal
biopsy): For lymphoma
protocol studies
for CSF
analysis in patients with:
Management:
The treatment of NHL
varies greatly and
include:
: Most
common; usually
combination regimens
: Possible
role in relapsed high-risk
disease
• Transfusions of blood
products
• Antibiotic
Pharmacotherapy
• Medications include: