Lymphoma

8,391 views
7,971 views

Published on

1 Comment
37 Likes
Statistics
Notes
No Downloads
Views
Total views
8,391
On SlideShare
0
From Embeds
0
Number of Embeds
54
Actions
Shares
0
Downloads
992
Comments
1
Likes
37
Embeds 0
No embeds

No notes for slide

Lymphoma

  1. 1. LYMPHOMA www.freelivedoctor.com
  2. 2. Lymphocytic Leukemia & Lymphoma <ul><li>The line between lymphocytic leukemia and lymphoma is often unclear </li></ul><ul><li>The terms merely describe the site of disease distribution </li></ul><ul><li>Leukemia: widespread involvement of BM and presence of large number of tumor cells in peripheral blood </li></ul><ul><li>Lymphoma: lymphoid proliferations as discrete tissue masses </li></ul>www.freelivedoctor.com
  3. 3. Lymphoma <ul><li>Non-Hodgkin’s Lymphoma (NHL) </li></ul><ul><li>Hodgkin Disease (HD) (Hodgkin’s Lymphoma) </li></ul>www.freelivedoctor.com Cotran, Kumar, Collins: Robbins PATHOLOGIC BASIS OF DISEASE
  4. 4. Non-Hodgkin Lymphoma classification <ul><li>Rappaport </li></ul><ul><li>Lukes-Collins </li></ul><ul><li>Working Formulation (1982) </li></ul><ul><li>Revised European-American Classification of Lymphoid Neoplasms (REAL) (1994) </li></ul><ul><li>World Health Organization Classification of Neoplastic and Lymphoid Tissues (WHO classification) (1999) </li></ul>www.freelivedoctor.com
  5. 5. Working Formulation <ul><li>Three(3) prognostic groups </li></ul><ul><li>pattern of tumor growth </li></ul><ul><li>size of tumor cells </li></ul>www.freelivedoctor.com
  6. 6. B-cell transformation www.freelivedoctor.com
  7. 7. REAL Classification <ul><li>B-cell neoplasms </li></ul><ul><li>1. Precursor B-cell neoplasms </li></ul><ul><li>2. Peripheral B-cell neoplasms </li></ul><ul><li>T-cell neoplasms </li></ul><ul><li>3. Precursor T-cell neoplasms </li></ul><ul><li>4. Peripheral T-cell neoplasms </li></ul><ul><li>Hodgkin Disease </li></ul>www.freelivedoctor.com
  8. 8. WHO Classification <ul><li>Non-Hodgkin lymphoma </li></ul><ul><ul><li>B cell : CD20, CD22, CD79 a </li></ul></ul><ul><ul><ul><li>pre-B cell tumor </li></ul></ul></ul><ul><ul><ul><li>peripheral B cell tumor </li></ul></ul></ul><ul><ul><li>T/NK cell : CD45RO </li></ul></ul><ul><ul><ul><li>pre-T cell tumor </li></ul></ul></ul><ul><ul><ul><li>peripheral T cell & NK cell tumor </li></ul></ul></ul><ul><li>Hodgkin lymphoma </li></ul>www.freelivedoctor.com
  9. 9. B cell lymphoma <ul><li>lymphoblastic leukemia/lymphoma </li></ul><ul><li>follicular lymphoma </li></ul><ul><li>chronic lymphocytic leukemia/small lymphocytic lymphoma </li></ul><ul><li>mantle cell lymphoma </li></ul><ul><li>prolymphocytic leukemia </li></ul><ul><li>hairy cell leukemia </li></ul><ul><li>lymphoplasmacytic lymphoma </li></ul><ul><li>marginal zone B cell lymphoma of mucosa associated lymphoid tissue (MALT)-type </li></ul><ul><li>nodal marginal zone B cell lymphoma </li></ul><ul><li>splenic marginal zone B cell lymphoma </li></ul><ul><li>Burkitt lymphoma </li></ul><ul><li>diffuse large B cell lymphoma </li></ul><ul><li>plasmacytoma </li></ul><ul><li>plasma cell myeloma </li></ul>WHO classification www.freelivedoctor.com
  10. 10. T/NK Cell Lymphoma <ul><li>lymphoblastic leukemia/lymphoma </li></ul><ul><li>T cell prolymphocytic leukemia </li></ul><ul><li>peripheral T cell lymphoma, unspecified </li></ul><ul><li>angioimmunoblastic T cell lymphoma </li></ul><ul><li>mycosis fungoides </li></ul><ul><li>Sezary syndrome </li></ul><ul><li>adult T cell leukemia/lymphoma </li></ul><ul><li>T cell large granular lymphocytic leukemia </li></ul><ul><li>anaplastic large cell lymphoma </li></ul><ul><li>primary cutaneous anaplastic large cell lymphoma </li></ul><ul><li>subcutaneous panniculitis-like T cell lymphoma </li></ul><ul><li>enteropathy-type intestinal T cell lymphoma </li></ul><ul><li>hepatosplenic gamma/delta T cell lymphoma </li></ul><ul><li>NK cell leukemia </li></ul><ul><li>nasal and nasal type NK/T cell lymphoma </li></ul>WHO classification www.freelivedoctor.com
  11. 11. common lymphoma/leukemia in adults <ul><li>follicular lymphoma </li></ul><ul><li>diffuse large B-cell lymphoma </li></ul><ul><li>chronic lymphocytic leukemia/small lymphocytic lymphoma </li></ul>www.freelivedoctor.com
  12. 12. Follicular Lymphoma <ul><li>Overview: -peripheral B-cell neoplasm </li></ul><ul><li>-most common NHL in U.S. </li></ul><ul><li>-45% of adult lymphomas </li></ul><ul><li>Morphology: -resembling nl germinal ctr cells </li></ul><ul><li>centrocytes </li></ul><ul><li>centroblasts </li></ul>www.freelivedoctor.com
  13. 13. Follicular Lymphoma <ul><li>Immunophenotype: </li></ul><ul><li>Pos: CD19, CD20, CD10 (CALLA), CD23 (+/-) </li></ul><ul><li>sIg </li></ul><ul><li>bcl 2 (  nl germinal center cells) </li></ul><ul><li>Neg: CD5 (  CLL/SLL, mantle cell lymphoma), CD43 </li></ul><ul><li>Genetics: t(14;18)  turning “on” bcl-2 </li></ul>www.freelivedoctor.com
  14. 14. Follicular Lymphoma <ul><li>Clinical: -75 to 80% of indolent B-cell lymphomas </li></ul><ul><li>-middle aged to older adults </li></ul><ul><li>-M = F </li></ul><ul><li>-generalized painless lymphadenopathy </li></ul><ul><li>-indolent waxing and waning course </li></ul><ul><li>prognosis: -incurable (mean survival : 7-9 yrs) </li></ul><ul><li>-aggressive therapy not effective </li></ul><ul><li>-30-50%  transformation to diffuse large cell lymphoma </li></ul>www.freelivedoctor.com
  15. 15. www.freelivedoctor.com
  16. 16. www.freelivedoctor.com
  17. 17. CD20 bcl-2 CD3 www.freelivedoctor.com
  18. 18. Diffuse Large B-cell Lymphoma <ul><li>Overview: -heterogeneous peripheral B-cell tumor </li></ul><ul><li>-20% of all NHL </li></ul><ul><li>-60-70% of aggressive lymphoid tumors </li></ul><ul><li>Morphology: -diffuse growth pattern </li></ul><ul><li>-large tumor cells </li></ul>www.freelivedoctor.com
  19. 19. Diffuse Large B-cell Lymphoma <ul><li>Immunophenotype: </li></ul><ul><li>Pos: CD19, CD20, CD22, CD79a, (CD10), sIg </li></ul><ul><li>Neg: TdT </li></ul><ul><li>Genetics: t(14;18) (= bcl-2 rearrangement)-- 30% of cases </li></ul><ul><li>various translocations --- 20 to 30% of cases </li></ul><ul><li>bcl 6 rearrangement (CH3) </li></ul><ul><li>extranodal lesions </li></ul><ul><li>negative for bcl 2 rearrangement </li></ul>www.freelivedoctor.com
  20. 20. Diffuse Large B-cell Lymphoma <ul><li>Clinical: -wide age range (median age : 60 y/o) </li></ul><ul><li>-slight male predominance </li></ul><ul><li>-rapidly enlarging mass (GI tract, skin, bone, brain, ORL lymphoid tissue, liver, spleen) </li></ul><ul><li>-aggressive behavior, but potentially curable </li></ul><ul><li>prognosis: responsive to intensive combination chemoRx </li></ul><ul><li>better prognosis: limited Dz, small lesion bcl 6 rearrangement </li></ul><ul><li>worse prognosis: p53 mutation </li></ul>www.freelivedoctor.com
  21. 21. Diffuse Large B-cell Lymphoma <ul><li>Special Subtypes </li></ul><ul><li>1. Immunodeficiency-associated large B-cell lymphoma </li></ul><ul><li>-with latent EBV infection </li></ul><ul><li>2. body cavity large B-cell lymphoma </li></ul><ul><li>-mostly seen in advanced HIV(+) patients </li></ul><ul><li>-arises as malignant pleural or ascitic effusion </li></ul><ul><li>-infected with human herpes virus 8 </li></ul>www.freelivedoctor.com
  22. 22. Chronic Lymphocytic Leukemia (CLL) Small Lymphocytic Lymphoma (SLL) <ul><li>Overview: -peripheral B-cell neoplasm </li></ul><ul><li>CLL: most common leukemia in Western World </li></ul><ul><li>SLL: 4% of NHL </li></ul><ul><li>-less common in Asia </li></ul><ul><li>Morphology: -diffuse involvement of LN architecture </li></ul><ul><li>-two(2) cell types (small & large) </li></ul>www.freelivedoctor.com
  23. 23. Chronic Lymphocytic Leukemia (CLL) Small Lymphocytic Lymphoma (SLL) <ul><li>Morphology: -frequent BM involvement </li></ul><ul><li>-interstitial infiltrates </li></ul><ul><li>-nonparatrabecular aggregates </li></ul><ul><li>-spleen: white and red pulp involvements </li></ul><ul><li>-liver: portal space involvement </li></ul>www.freelivedoctor.com
  24. 24. Chronic Lymphocytic Leukemia (CLL) Small Lymphocytic Lymphoma (SLL) <ul><li>Immunophenotype: </li></ul><ul><li>Pos: CD19, CD20, CD79a, CD5 </li></ul><ul><li>CD23 ( mantle cell lymphoma) </li></ul><ul><li>sIg heavy chain --- low level </li></ul><ul><li>sIg light chain </li></ul><ul><li>Genetics: trisomy 12 (~30% of cases) </li></ul><ul><li>del 13q12-14 (20-30% of cases) </li></ul><ul><li>del 11q (20-30% of cases) </li></ul><ul><li>t(11;14) bcl-1 </li></ul>www.freelivedoctor.com
  25. 25. Chronic Lymphocytic Leukemia (CLL) Small Lymphocytic Lymphoma (SLL) <ul><li>Clinical: -over 50 y/o </li></ul><ul><li>-male dominant (M:F = 2:1) </li></ul><ul><li>-often asymptomatic </li></ul><ul><li>-generalized lymphadenopathy (50-60%) </li></ul><ul><li>-hepatosplenomegaly (50-60%) </li></ul><ul><li>-disruption of immune function </li></ul><ul><li>hypogammaglobulinemia </li></ul><ul><li>autoimmune disorders </li></ul><ul><li>hemolytic anemia </li></ul><ul><li>thrombocytopenia </li></ul>www.freelivedoctor.com
  26. 26. Chronic Lymphocytic Leukemia (CLL) Small Lymphocytic Lymphoma (SLL) <ul><li>course and prognosis depend on clinical stage </li></ul><ul><li>better prognosis: minimal tumor mass </li></ul><ul><li>worse prognosis: trisomy 12 </li></ul><ul><li>del 11q </li></ul><ul><li>terminal transformation to more aggressive tumors </li></ul><ul><li>transformation: </li></ul><ul><li>1. prolymphocytic transformation (15-30%) </li></ul><ul><li>2. Richter syndrome (5-10%) </li></ul><ul><li>transformation to diffuse large B cell tumor </li></ul>www.freelivedoctor.com
  27. 27. Common Lymphoma/Leukemia in Children <ul><li>Acute Lymphoblastic Leukemia/Lymphoma (ALL) </li></ul><ul><li>Burkitt Lymphoma </li></ul>www.freelivedoctor.com
  28. 28. Acute Lymphoblastic Leukemia/Lymphoma (ALL) <ul><li>Overview: predominantly B-cell tumor (85%) </li></ul><ul><li>T-cell tumors tend to be seen in adolescent males with frequent thymic involvement </li></ul><ul><li>differential diagnosis from AML is important </li></ul><ul><li>Morphology: PAS(+) cytoplasmic granules </li></ul><ul><li>absence of peroxidase(+) granules (  AML) </li></ul>www.freelivedoctor.com
  29. 29. Acute Lymphoblastic Leukemia/Lymphoma (ALL) <ul><li>Immunophenotype: TdT (+) --- >95% of cases </li></ul><ul><li>Genetics: t(12;21) --- preB-cell type </li></ul><ul><li>t(9;22) ----- 3% of children, 25% of adults </li></ul><ul><li>t(4;11) </li></ul><ul><li>hyperdiploidy </li></ul><ul><li>pseudodiploidy </li></ul>www.freelivedoctor.com
  30. 30. Burkitt Lymphoma <ul><li>Overview: relatively mature B-cell tumor </li></ul><ul><li>three(3) subtypes: </li></ul><ul><li>1. African(endemic) Burkitt lymphoma </li></ul><ul><li>2. sporadic(nonendemic) Burkitt lymphoma </li></ul><ul><li>3. HIV-associated neoplasm </li></ul>www.freelivedoctor.com
  31. 31. Burkitt Lymphoma <ul><li>Morphology: </li></ul><ul><ul><li>diffuse infiltrate of intermediate-size tumor cells </li></ul></ul><ul><ul><ul><li>round to oval nucleus </li></ul></ul></ul><ul><ul><ul><li>coarse chromatin </li></ul></ul></ul><ul><ul><ul><li>several nucleoli </li></ul></ul></ul><ul><ul><ul><li>moderate amount of basophilic cytoplasm with vacuoles </li></ul></ul></ul><ul><ul><li>high mitotic rate </li></ul></ul><ul><ul><li>apoptotic tumor cell death </li></ul></ul><ul><ul><li>numerous macrophages (‘starry sky” appearance) </li></ul></ul>www.freelivedoctor.com
  32. 32. Burkitt Lymphoma <ul><li>Immunophenotype: </li></ul><ul><li>sIgM, light chain </li></ul><ul><li>CD19, CD20, CD10 </li></ul><ul><li>CD5 -, CD23 - </li></ul><ul><li>Genetics: </li></ul><ul><li>translocation of c-myc gene </li></ul><ul><li>t(8;14) </li></ul><ul><li>t(2;8) </li></ul><ul><li>t(8;22) </li></ul><ul><li>EBV infection </li></ul><ul><li>100% of African Burkitt </li></ul><ul><li>25% of HIV-associated Burkitt </li></ul>www.freelivedoctor.com
  33. 33. Burkitt Lymphoma <ul><li>Clinical: children and young adults </li></ul><ul><li>frequent extranodal involvement </li></ul><ul><li> African Burkitt: mandible </li></ul><ul><li>abdominal organs (kidneys, ovaries, adrenal) </li></ul><ul><li> nonendemic Burkitt: ileocecum </li></ul><ul><li> peritoneum </li></ul><ul><li>prognosis: generally aggressive tumor, but responds well to therapy </li></ul>www.freelivedoctor.com
  34. 34. Mantle Cell Lymphoma <ul><li>Overview: peripheral B-cell tumor </li></ul><ul><li>3% of NHL in U.S. (7-9% in Europe) </li></ul><ul><li>Morphology: two(2) patterns of LN involvement </li></ul><ul><li> 1. mantle zone pattern </li></ul><ul><li> 2. diffuse pattern </li></ul>Normal www.freelivedoctor.com
  35. 35. normal lymphnode Rubin & Farber: Pathology, 2nd ed, Lippincott www.freelivedoctor.com
  36. 36. Mantle Cell Lymphoma <ul><li>Morphology: -homogeneous population of small lymphocytes </li></ul><ul><li>-absence of centroblast-like cells </li></ul>nucleus: round to irregular occasionally cleaved condensed chromatic inconspicuous nucleoli scant cytoplasm www.freelivedoctor.com
  37. 37. Mantle Cell Lymphoma <ul><li>Immunophenotype: </li></ul><ul><li>Pos: CD19 , CD20, CD5 (aberrant), CD43 </li></ul><ul><li>sIgM, sIgD </li></ul><ul><li>light chain (  or  ) </li></ul><ul><li>Neg: CD10, CD23 ( B-CLL/SLL) </li></ul><ul><li>Genetics: t(11;14) (  elevated cyclin D1 ) -- 70% of cases </li></ul><ul><li> involving bcl 1 gene  loss of cell cycle control </li></ul>www.freelivedoctor.com
  38. 38. Mantle Cell Lymphoma <ul><li>Clinical: -males in 40’s, 50’s and older </li></ul><ul><li>-generalized lymphadenopathy (widespread) </li></ul><ul><li>-BM: para- and non-trabecular aggregates </li></ul><ul><li>-extranodal involvement including liver & spleen </li></ul><ul><li>“ lymphomatoid polyposis” </li></ul><ul><li>multifocal entero-colic mucosal involvement </li></ul><ul><li>prognosis: poor (median survival : 3-5 yrs) </li></ul><ul><li>not curable with conventional chemotherapy </li></ul><ul><li>death due to organ dysfunction </li></ul>www.freelivedoctor.com
  39. 39. Marginal Zone Lymphoma <ul><li>Overview: -peripheral B-cell tumor </li></ul><ul><li>-tumors of mucosa-associated lymphoid tissue (“MALToma”) </li></ul><ul><li>-association with autoimmune or infectious chronic inflammatory disorders </li></ul><ul><li>Morphology: -resembling marginal zone B-cells </li></ul><ul><li>-various stages of B lymphoid differentiation </li></ul><ul><li>-”lymphoepithelial lesion” </li></ul>www.freelivedoctor.com
  40. 40. Marginal Zone Lymphoma (MALToma) L-26 UCHL-1 www.freelivedoctor.com
  41. 41. Marginal Zone Lymphoma <ul><li>Immunophenotype: </li></ul><ul><li>Pos: sIg, (cIg), CD19, CD20, CD22, CD79a </li></ul><ul><li>Neg: CD5 ( B-CLL/SLL, mantle cell lymphoma) </li></ul><ul><li>CD10 ( follicular lymphoma) </li></ul><ul><li>CD23 </li></ul><ul><li>Genetics: trisomy 18 </li></ul><ul><li>t(11;18) </li></ul><ul><li>polyclonal-to-monoclonal transition over time </li></ul>www.freelivedoctor.com
  42. 42. Marginal Zone Lymphoma <ul><li>Clinical: -majority of low-grade gastric lymphomas </li></ul><ul><li>-middle-aged adult </li></ul><ul><li>-frequently arises at extranodal sites </li></ul><ul><li>-within chronically inflamed tissue </li></ul><ul><li>salivary glands (Sjögren disease) </li></ul><ul><li>thyroid (Hashimoto thyroiditis) </li></ul><ul><li>stomach ( Helicobacter gastritis) </li></ul><ul><li>-localized for long periods of time </li></ul><ul><li>prognosis: 50% behave as low-grade lymphoma </li></ul><ul><li>may transform into diffuse large B-cell lymphoma </li></ul>www.freelivedoctor.com
  43. 43. Adult T-Cell Leukemia/Lymphoma <ul><li>Overview: CD4(+) T-cell neoplasm </li></ul><ul><li>infectious etiology (HTLV-1) </li></ul><ul><li>Morphology: multilobated nuclei (“clover leaf-” or “flower” cells) </li></ul><ul><li>multinucleated giant cells </li></ul><ul><li>mixture of </li></ul><ul><li>large cells </li></ul><ul><li>small cells </li></ul>www.freelivedoctor.com
  44. 44. Adult T-Cell Leukemia/Lymphoma <ul><li>Immunophenotype: CD2, CD3, CD5, but CD7 - </li></ul><ul><li>CD4, CD25 </li></ul><ul><li>CD8 (rare) </li></ul><ul><li>Genetics: clonal HTLV-1 provirus in tumor cells </li></ul>www.freelivedoctor.com
  45. 45. Adult T-Cell Leukemia/Lymphoma <ul><li>Clinical: -most frequently seen in HTLV-1 endemic areas </li></ul><ul><li>-adults </li></ul><ul><li>-generalized lymphadenopathy </li></ul><ul><li>-BM involvement </li></ul><ul><li>-hepatosplenomegaly </li></ul><ul><li>-peripheral blood lymphocytosis </li></ul><ul><li>-hypercalcemia </li></ul><ul><li>prognosis: two(2) types of clinical manifestation </li></ul><ul><li>1. rapidly progressive disease </li></ul><ul><li>2. indolent cutaneous disease </li></ul>www.freelivedoctor.com
  46. 46. Mycosis Fungoides/Sëzary Syndrome <ul><li>Overview: -indolent peripheral CD4(+) T-cell disorders </li></ul><ul><li>-different manifestations of a single process (cutaneous T-cell lymphoid neoplasms) </li></ul><ul><li>Morphology: “cerebriform nuclei” </li></ul>www.freelivedoctor.com
  47. 47. Mycosis Fungoides/Sëzary Syndrome <ul><li>Immunophenotype: CD4, T-cell receptor  /  </li></ul><ul><li> CD3, CD2, CD5 </li></ul><ul><li>Genetics: no specific chromosomal abnormality </li></ul>www.freelivedoctor.com
  48. 48. Mycosis Fungoides/Sëzary Syndrome <ul><li>Clinical: </li></ul><ul><li>mycosis fungoides </li></ul><ul><li>-infiltration of neoplastic T-cells in epidermis and upper dermis </li></ul><ul><li>-three(3) stages </li></ul><ul><li>1. “inflammatory” premycotic phase </li></ul><ul><li>2. plaque phase </li></ul><ul><li>3. tumor phase </li></ul><ul><li>-extracutaneous spread (LN, BM) </li></ul><ul><li>Sëzary syndrome </li></ul><ul><li>-generalized exfoliative erythroderma </li></ul><ul><li>-occasional terminal transformation to large T-cell lymphoma </li></ul>www.freelivedoctor.com
  49. 49. Hodgkin Disease www.freelivedoctor.com
  50. 50. Reed-Sternberg (RS) Cell <ul><li>neoplastic, diagnostic cell of Hodgkin Disease </li></ul><ul><li>large cells with abundant eosinophilic cytoplasm </li></ul><ul><li>“ owl’s eye” or multi-lobed nuclei </li></ul><ul><li>distinct, irregularly thickened nuclear membranes </li></ul><ul><li>prominent eosinophilic nucleoli </li></ul>www.freelivedoctor.com
  51. 51. Hodgkin Disease classification <ul><li>1. lymphocyte predominance (15%) </li></ul><ul><li>2. nodular sclerosis (30-50%) </li></ul><ul><li>3. mixed cellularity (20-40%) </li></ul><ul><li>4. lymphocyte depletion (10-15%) </li></ul><ul><li>(5. lymphocyte-rich classic Hodgkin disease) </li></ul>www.freelivedoctor.com
  52. 52. Hodgkin Disease lymphocyte predominance <ul><li>large # of mature lymphocyte admixed with variable # of benign histiocytes </li></ul><ul><li>effacement of LN architecture </li></ul><ul><li>scarce RS cells </li></ul><ul><li>males, <35 y/o </li></ul><ul><li>localized cervical or axillary lymphadenopathy (stage I or II) </li></ul><ul><li>excellent prognosis </li></ul>www.freelivedoctor.com
  53. 53. Hodgkin Disease nodular sclerosis <ul><li>“ lacunar cell” variant of RS cell with fixation artifact large cell with hyperlobated nucleus multiple small nucleoli abundant pale cytoplasm </li></ul><ul><li>bifringent collagen bands </li></ul><ul><li>F > M, teen-age & young adults </li></ul><ul><li>mediastinal, supraclavicular, lower cervical LNs </li></ul><ul><li>excellent prognosis </li></ul>www.freelivedoctor.com
  54. 54. Hodgkin Disease mixed cellularity <ul><li>diffuse infiltrate of eosinophils, PMNs, plasma cells and histiocytes </li></ul><ul><li>plentiful RS cells </li></ul><ul><li>M > F </li></ul><ul><li>biphasic age distribution </li></ul><ul><li>1. young adult </li></ul><ul><li>2. >55 y/o </li></ul><ul><li>more advanced stage (stage III or IV) </li></ul><ul><li>intermediate prognosis </li></ul>www.freelivedoctor.com
  55. 55. Hodgkin Disease lymphocyte depletion <ul><li>older male </li></ul><ul><li>disseminated disease (stage III or IV) </li></ul><ul><li>also seen in HIV(+) patients </li></ul><ul><li>more aggressive clinical course </li></ul>www.freelivedoctor.com
  56. 56. Hodgkin Disease staging <ul><li>Stage I : limited to one lymph node region </li></ul><ul><li>Stage II : limited to two lymph node regions, on same side of diaphragm </li></ul><ul><li>Stage III : limited to lymph nodes but on both sides of diaphragm </li></ul><ul><li>Stage IV : involving extranodal tissue </li></ul><ul><li>A: no systemic symptoms </li></ul><ul><li>B: with systemic symptoms (fever, night sweats, wt. loss, etc) </li></ul>www.freelivedoctor.com
  57. 57. Hodgkin Disease prognosis <ul><li>65% ten(10)-year survival with treatment </li></ul><ul><li>better prognosis: young age low stage </li></ul>www.freelivedoctor.com

×