descripe what the hodgekins lymphoma

1. Hodgkin's lymphoma
(Hodgkin's disease)
ODAI RJOUB (STUDENT) - HEBRON UNIVERSITY-
BIOLOGY DEPARTMENT-

2. Def:
is a chronic ( in rare case acute) disease ,the growth of the
tumor cells take place mainly in the lymphatic node.
Hodgkin's disease, is a type of lymphoma, which is a type of
cancer originating from white blood cells called
lymphocytes.

3. History:
It was named after Dr. Thomas Hodgkin, who
first described abnormalities in the lymph system in
1832.
Dorothy Reed and Carl Stenberg first
described the malignant cells of Hodgkin’s lymphoma
called Reed Stenberg cells.
1798-1866

4. Sign and symptoms:(Clinical features)
 Night Sweats
 Unexplained weight loss
 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
 Splenomegaly: enlargement of the spleen occurs in about 30%
of people with Hodgkin's lymphoma
 Hepatomegaly: enlargement of the liver

5. 1. Painless Lymphadenopathy –
involving superficial lymph nodes of cervical and (Dsupraclavicular
nodes)
• The lymph nodes are swollen and have a rubbery feeling
2. Systemic Symptoms
a) Fevers, Night Sweats and Weight Loss
b) Pruritus
c) Pel-Ebstein Fever
e) cough and dyspnoea.
3. Pain
a) Alcohol – induced pain
b) Abdominal Pain
c) Bone Pain
d) Neurogenic Pain
e) Back Pain
f) chest pain

6. Famous People With Hodgkin's Disease:
• Paul Allen- Investor and co-founder of Microsoft
Corporation.
• Charles Lindbergh- The first pilot to make a transatlantic
flight.
• Jackie Kennedy- Former First Lady
• Gene Wilder- Actor

7. Causes:
 The exact cause of Hodgkin's lymphoma is unknown
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.
 A key step in Hodgkin's lymphoma involves the
development of abnormal B cells.

8. REAL* Classification
Classic:
1. Nodular Sclerosis
2.Lymhocyte rich
3. Mixed Cellularity
4. Lymphocyte depleted
Non-Classic:
Nodular lymphocyte predominant Hodgkins lymphoma
(NLPHL)

9. Classic:
1.Nodular Sclerosis:
Most common type diagnosed.
About 70% of adolescents
 Lacunar cells are seen
40% of younger patients
CD 15 and 30 positive
EBV negative
Only subtype without a male predominance
Seen in younger pts with stage I – II disease

10. 2. Lymphocyte-Rich:
This was introduced by the World
Health Organization classification in
1999.
RS cells CD15+, CD30+; 40% EBV+
Uncommon
M > F
Tends to be seen in older adults
This is an uncommon form of classical HL

11. 3. Mixed Cellularity:
Constitutes about 20%
 More common in young children
CD 15,30 EBV positive
Presents in advanced stages
Tendency to involve spleen , bone marrow
 More than 50% present as stage III or IV disease
Biphasic incidence, peaking in young adults and again in adults
older than 55

12. 4. Lymphocyte depleted:
Constitutes <5%
RS cells CD15+, CD30+; most EBV+
Worst prognosis of all subtypes
Present as febrile illness with
pancytopenia, hepatomegaly,
and no peripheral lymphadenopathy
Older males , rare in children
Advanced stage , Stage IV
 HIV infection

13. Non-Classic:
Lymphocyte predominant Hodgkins lymphoma
<5% of Hodgkins lymphoma
Mainly involves cervical ,
axillary or mediastinal
“L&H” cells or Popcorn
cells are seen
Positive for CD20,45
Negative for CD15,30.EBV

14. Ann Arbor Staging Classification for
Hodgkin Disease:
Stage I:
Involvement of a single lymph node (1) or of a single
extra lymphatic site or organ(1f)
 Stage II:
Involvement of two or more lymph node regions
on the same side of the diaphragm(II)
or localised involvement of an extra lymphatic
Site or organ and one or more lymph node regions
on the same side of the diaphragm (IIf)

15. Stage III:
Involvement of lymph node regions on both sides of
the diaphragm (III) which may be accompanied by the
involvement of spleen (IIIS) or by localized involvement of
an extra lymphatic site or organ ( IIIf) or both ( IIIsf)
Stage IV:
Diffuse or disseminated involvement of one or more
extra lymphatic organs or tissues with or without associated
lymph node involvement. involvement of liver or bone
marrow

16. Epidemiology:
Most frequently (Bimodal)occur in age group 15 to 35 and >50
years
More common in males except Nodular Sclerosis which is more
common in females
Increase incidence in HIV infections.
Bimodal incidence
Early peak middle to late 20s Second peak after 50 yearr
Immunodeficiency

17. Sex (Male : Female)
4: 1 for 3-7 yr
3: 1 for 7-9 yr
1-3: 1 for > 10 yr
100 folds risk for unaffected monozygotic twin of affected
twin
Associated with specific HLA antigen
Infectious agents
Human herpes virus 6
CMV
Epstein – Barr virus

18. Risk Factors Hodgkins:
Family History
 Environmental – wood workers, farmers, meat workers
Diseases- Mononucleosis (EBV infection), AIDS, Bone marrow
transplant.
HIV

19. Complication:
 Renal amyloidosis followed by contracted kidney and uremia
 Intoxication
 Septic complication
 Cardiovascular disease
 Second malignancy, such as leukemia, non-Hodgkin's lymphoma
and tumors in the lungs, breasts or gastrointestinal system
 Vascular disease, including stroke
 Thyroid dysfunction
 Sterility

20. Diagnostic:

21.  CBC
 LIVER FUNCTION
 RENAL FUNCTION
 SERUM ALBUMIN
 Serum Copper & Ferritin
 ESR
 LACTEATE DEHYDROGENASE
 BONE MAROW BIOBSEY

22. Bone Marrow Biopsy:

23. PET SCAN:

24. TREATMENT:
Treatment depends on :
Stage of the disease
Age at diagnosis
Presence / absence of B symptoms
Presence of hilar lymphadenopathy
Presence of bulky nodal disease
Current Treatment Regimen:
Combined chemotherapy with or without low
dose involved field radiation therapy.

25. 1.Chemotherapy:
MOPP
COPP
ABVD
 BEACOPP

26. Radiotherapy:
 Radiation therapy is the most effective single thrapeutic
agent for treating Hodgkin lymphoma.
The main objective of radiation in Hodgkin lymphoma is
to treat involved and contiguous field.
Radiotherapy can be given by
1. 2D planning
2. 3D planning
3. IFRT
Involved field radiotherapy is the most commonly used
technique at present. It targets a smaller area rather than a
classical extended field.

27. Conclusion:
Radiation therapy is the most effective single therapeutic
agent for treating Hodgkins lymphoma
The management of Hodgkins lymphoma has evolved from
extended field radiation to a combined modality of chemo
radiation or chemo alone.
Interest is in achieving the best therapeutic ratio by
minimizing late toxicity while maintaining effectiveness.
With improvement in diagnostic modality and PET
scanning and improved treatment policy the results in
future will be encouraging

28. IFRT
Involved field radiotherapy.
IFRT is the most commonly used technique at present
Targets a smaller area rather than a classical extended field.
IFRT(ASTRO 2002)DEFINITION
IFRT encompasses region and not an individual lymph node.
Initially involved Pre chemo sites and volume are treated
Exception to above rule is for transverse diameter of
mediastinum and paraaortic lymphnodes for which reduced post
chemo volume is treated.

29. Thank you