Hodgkins Lymphoma


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Hodgkins Lymphoma

  1. 1. Hodgkin's Lymphoma
  2. 2. definition <ul><li>Hodgkin's lymphoma is a chronic ( in rare case acute) disease ,the growth of the tumor cells take place mainly in the lymphatic node. </li></ul><ul><li>Hodgkin's lymphoma, previously known as Hodgkin's disease, is a type of lymphoma, which is a type of cancer originating from white blood cells called lymphocytes. It was named after Thomas Hodgkin, who first described abnormalities in the lymph system in 1832 </li></ul><ul><li>As Hodgkin's lymphoma progresses, it compromises your body's ability to fight infection. </li></ul>
  3. 3. New classification <ul><li>Hodgkin’s lymphoma has been subdivided into two main categories: </li></ul><ul><li>1) Nodular Lymphocyte-predominant Hodgkin’s Lymphoma (NLPHL) </li></ul><ul><li>It is no longer classified as a form of classic Hodgkin's lymphoma (HL). This is because the Reed-Sternberg Cell (RSC) variants (popcorn cells) that characterize this form of the disease invariably express B lymphocyte markers such as CD20 (thus making NLPHL an unusual form of B cell lymphoma), and that (unlike classic HL) NLPHL may progress to diffuse large B cell lymphoma. </li></ul><ul><li>2) Classical Hodgkin’s Lymphoma. </li></ul>
  4. 4. Sign and symptoms <ul><li>Night Sweats </li></ul><ul><li>Unexplained weight loss </li></ul><ul><li>Lymph nodes: the most common symptom of Hodgkin's is the painless enlargement of one or more lymph nodes. The nodes may also feel rubbery and swollen when examined </li></ul><ul><li>Splenomegaly: enlargement of the spleen occurs in about 30% of people with Hodgkin's lymphoma </li></ul><ul><li>Hepatomegaly: enlargement of the liver, due to liver involvement, is present in about 5% of cases. </li></ul><ul><li>Hepatosplenomegaly: the enlargement of both the liver and spleen caused by the same disease. </li></ul><ul><li>Pain </li></ul><ul><li>Red-coloured patches on the skin, easy bleeding and petechiae due to low platelet count </li></ul><ul><li>Coughing, trouble breathing or chest pain </li></ul><ul><li>Loss of appetite </li></ul><ul><li>Itching </li></ul><ul><li>Increased sensitivity to the effects of alcohol or pain in your lymph nodes after drinking alcohol </li></ul>
  5. 5. causes <ul><li>The exact cause of Hodgkin's lymphoma is unknown. </li></ul><ul><li>Hodgkin's lymphoma commonly begins in lymph nodes located in the upper part of your body. Some lymph nodes are in areas more readily noticed, such as in your neck, above your collarbone, under your arms or in your groin area. Enlarged lymph nodes in the chest cavity also are common. Eventually, Hodgkin's lymphoma may spread outside your lymph nodes to virtually any part of your body. </li></ul><ul><li>A key step in Hodgkin's lymphoma involves the development of abnormal B cells. </li></ul>
  6. 6. Abnormal B-cell <ul><li>B cells are a type of lymph cell that's an important part of your immune system's response to foreign invaders. B cells normally work with T cells, which mature in the thymus, to fight infection. </li></ul><ul><li>When B cells develop into large abnormal cells , these abnormal, cancerous cells are called Reed-Sternberg cells . Instead of undergoing the normal cell cycle of life and death, Reed-Sternberg cells don't die , and they continue to produce abnormal B cells in a malignant process. These cells also attract other normal immune cells that cause the lymph nodes to enlarge. </li></ul>
  7. 7. morphological <ul><li>Local </li></ul><ul><li>in isolated lymphogranulomatosis, one group of lymphatic node are involved( cervical,mediastinal,retroperitoneal) </li></ul><ul><li>General </li></ul><ul><li>the growth of tumour cells occurs not only in the primary focus but also far fron it. As a rule the spleen is involved. </li></ul><ul><li>Its pulp is red with numerous white yellow foci of necrosis and sclerosis, so called «diffuse waxy spleen» </li></ul><ul><li>The process become generalized due to metastasis from primary node. </li></ul>
  8. 8. Clinico morphology <ul><li>Variant 1: with prevail of lymphoid tissue( lymphohistocyte) </li></ul><ul><li>Variant 2: nodular sclerosis </li></ul><ul><li>Variant 3: mixed-cell variant </li></ul><ul><li>Variant 4: with inhibition of lymphoid tissue </li></ul>
  9. 9. macroscopy <ul><li>Affected lymph nodes (most often, laterocervical lymph nodes) are enlarged, but their shape is preserved because the capsule is not invaded. Usually, the cut surface is white-grey and uniform; in some histological subtypes (e.g. nodular sclerosis) a nodular aspect may appear. </li></ul><ul><li>A fibrin ring granuloma may be seen. </li></ul>
  10. 10. Microscopy study <ul><li>Microscopic examination of the lymph node biopsy reveals complete or partial effacement of the lymph node architecture by scattered large malignant cells known as Reed-Sternberg cells (RSC) (typical and variants) admixed within a reactive cell infiltrate composed of variable proportions of lymphocytes, histiocytes, eosinophils, and plasma cells. </li></ul><ul><li>The Reed-Sternberg cells are identified as large often bi-nucleated cells with prominent nucleoli and an unusual immunophenotype. </li></ul><ul><li>In approximately 50% of cases, the Reed-Sternberg cells are infected by the Epstein-Barr virus. </li></ul><ul><li>Demonstrate proliferation of lymphocytes, histiocytes, reticulocytes, eosinophiles,plasmoblasts and plasmocytes,neutrophiles </li></ul><ul><li>These cell form accumulation of the nodes with necrotic and sclerotic changes. </li></ul><ul><li>Atypical cell (small hogdkin's cells, mononuclear giant cells or large hogdkin's cells) are revealed . </li></ul>
  11. 11. Complication <ul><li>Renal amyloidosis followed by contracted kidney and uremia </li></ul><ul><li>Intoxication </li></ul><ul><li>Septic complication </li></ul><ul><li>Cardiovascular disease </li></ul><ul><li>Second malignancy, such as leukemia, non-Hodgkin's lymphoma and tumors in the lungs, breasts or gastrointestinal system </li></ul><ul><li>Vascular disease, including stroke </li></ul><ul><li>Thyroid dysfunction </li></ul><ul><li>Sterility </li></ul><ul><li>Death </li></ul>
  12. 12. People with hodgkin's lymphoma
  13. 13. Chronic hodgkin's lymphoma <ul><li>The glands are usually larger than in tuberculosis, and they remain longer discrete and movable; they are firm in consistence, and on section present a granular appearance due to overgrowth of the connective-tissue framework. </li></ul>
  14. 14. Hodgkin's disease(at neck and axillary) <ul><li>Lymphadenoma (Hodgkin's Disease) affecting left side of neck and left axilla, in a woman at 44. Three years' duration. </li></ul>
  15. 15. Classical Hodgkin's Lymphoma : Nodular Sclerosis(1) <ul><li>Classical Hodgkin’s Lymphoma, Nodular Sclerosis: The lymph node is massively enlarged and has a nodular appearance due to bands of fibrosis. </li></ul>
  16. 16. Classical Hodgkin's Lymphoma : Nodular Sclerosis(2) Classical Hodgkin’s Lymphoma, Nodular Sclerosis: In more advanced cases of Hodgkin’s Lymphoma, several lymph nodes from the same group may become matted together, as seen in this group of mediastinal lymph nodes. Note the anthracotic pigment in some lymph nodes. The specimen measured 12 cm. in greatest dimension
  17. 17. Hodgkin's disease at liver. <ul><li>Hodgkin's disease (lymphoma) is a malignant cancer that can affect many organs. A whitish, irregular tumor mass of lymphoma cells is seen on the left side of this cross-section of the liver. </li></ul>
  18. 18. Primary Hodgkin’s lymphoma of spleen <ul><li>78 y/o man with hepatosplenomegaly. Splenectomy specimen showed scattered gray-white nodules. The tumor cells were positive for CD15, CD30, CD20 (partial) and negative for CD45. Spleen is the most common extranodal site of involvement in Hodgkin’s lymphoma. Primary Hodgkin’s lymphoma of spleen is rare. </li></ul>
  19. 19. Spleens involved by Hodgkin’s lymphoma(show a single or a few large nodules) <ul><li>Spleens involved by Hodgkin’s lymphoma may show a single or a few large nodules (shown here) or multiple smaller nodules with a miliary distribution (previous image). Sometimes, small nodules may be inconspicuous and require meticulous sectioning </li></ul>
  20. 20. Nodular Sclerosis type(in lymph node) In Classical Hodgkin’s Lymphoma, Nodular Sclerosis type, broad collagen bands separate the lymphoid tissue into nodules
  21. 21. Classical Hodgkin's Lymphoma : Nodular Sclerosis (Reed-Sternberg Cells)-lymph node <ul><li>The conventional definition of Hodgkin’s lymphoma requires the presence of Reed-Sternberg cells (many are seen in this image) in a characteristic background infiltrate composed of eosinophils, lymphocytes, plasma cells, and histiocytes. It lacks the monomorphic appearance of non-Hodgkin’s lymphomas </li></ul>
  22. 22. Classical Hodgkin's Lymphoma : Nodular Sclerosis (Syncytial variant) In some cases of Classical Hodgkin’s Lymphoma, Nodular Sclerosis type, the lacunar cells form cohesive sheets (seen here as lighter staining areas in lymphoid nodules. Such cases have been referred to as syncytial variant. When this feature is pronounced, these cases may be mistakenly diagnosed as non-Hodgkin’s lymphoma, metastatic carcinoma, or even thymoma
  23. 23. Classical Hodgkin's Lymphoma : Lymphocyte Depleted A Reed-Sternberg cell is seen in a background of eosinophils, lymphocytes, and macrophages. Lymphocyte-depleted is the most aggressive type of Hodgkin’s lymphoma, commonly associated with advanced stages at presentation
  24. 24. Mixed Cellularity High-power view showing numerous Reed-Sternberg cells in this case of Classical Hodgkin’s Lymphoma, Mixed Cellularity type Mixed Cellularity type accounts for 20% to 25% of cases of Classical Hodgkin’s Lymphoma. Reed-Sternberg cells are present in a background of eosinophils, plasma cells, lymphocytes, and atypical mononuclear cells. Fibrosis is usually absent.
  25. 25. Nodular Lymphocyte-Predominant Hodgkin's Lymphoma In Nodular Lymphocyte-predominant Hodgkin’s Lymphoma, classic Reed-Sternberg cells, eosinophils, plasma cells, and areas of fibrosis are absent. Instead, numerous L&H cells with multilobed, folded nucleus with small nucleoli are present in a background rich in lymphocytes.
  26. 26. Nodular Lymphocyte-Predominant Hodgkin's Lymphoma A close-up of L&H cell (popcorn cell) in a case of Nodular Lymphocyte-predominant Hodgkin’s Lymphoma. It has a large, multilobed, folded nucleus and is surrounded by small lymphocytes. L&H cells are of B-cell lineage and express pan-B-cell markers *(L&H(lymphocyte and histiocytic)
  27. 27. Reed-Sternberg cells(higher magnification-in spleen) <ul><li>Hig her magnification view shows Reed-Sternberg cells with inclusion-like macronucleoli and abundant cytoplasm, surrounded by lymphocytes, macrophages, and occasional eosinophil. </li></ul>
  28. 28. Micrograph of hodgkin's lymphoma <ul><li>The micrograph shows a mixture of cells common in hodgkin's lymphoma» </li></ul><ul><li>Eosinophils,Reed-Sternberg cells,Plasma cells,histocyte. </li></ul>
  29. 29. Reed-sternberg cell <ul><li>Reed-Sternberg cell; photograph shows normal lymphocytes compared with a Reed-Sternberg cell, which are large, abnormal lymphocytes that may contain more than one nucleus. These cells are found in Hodgkin lymphoma </li></ul>