Hodgkin's lymphoma

1. HODGKIN'S LYMPHOMA
By- Dr. Armaan Singh

2. Hodgkin's lymphoma is a
malignant tumor of the lymphatic system
that is characterised histologically by the
presence of multinucleated giant cells
(Reed-Sternberg cells) and associated
abnormal and smaller mononuclear cells
originating from B lymphocytes in the
germinal centres of lymphoid tissue.

3. SYMPTOMS:
 Most patients present with an enlarged but otherwise asymptomatic lymph
node, typically in the lower neck or supraclavicular region.
 Mediastinal masses are frequent and are sometimes discovered on a
routine CXR.
 Patients might complain of chest discomfort with a cough or dyspnoea.
 Systemic symptoms of drenching night sweats, unexplained fever >38°C,
and weight loss of >10% over six months are termed B symptoms and are
identified in approximately 25% of patients.Alcohol-induced pain at sites of
nodal disease is specific but occurs in fewer than 10% of patients.
 Findings on examination include lymphadenopathy, hepatomegaly,
splenomegaly, and superior vena cava syndrome; there may also be
features caused by paraneoplastic syndromes - eg, cerebellar
degeneration, neuropathy or Guillain-Barré syndrome.

4. DIFFERENTIAL DIAGNOSIS
 Infectious mononucleosis, AIDS, Non-Hodgkin's lymphoma,
Tuberculosis, Leukaemia, Sarcoidosis
 Myeloma, Toxoplasmosis, Cytomegalovirus infection,Tularaemia
 Radiation therapy, chemotherapy or combined therapies are the
treatments used in managing Hodgkin's lymphoma.
 Both chemotherapy and radiation therapy increase the risk of
developing secondary solid tumours - eg, cancers of the lung,
breast, and stomach.
 Vaccinations: polyvalent pneumococcal vaccine and influenza
vaccine should be given to all patients with Hodgkin's lymphoma.
Meningococcal group C conjugate vaccine and Haemophilus
influenzae type b vaccine are also recommended, especially for
patients receiving treatment and those with asplenia or splenic
dysfunction.
 The role of allogeneic hematopoietic stem cell transplantation for
Hodgkin's lymphoma is being explored.