HODGKINS NON-HODGKINS
OFTEN LOCALIZED
LESION
MULTIPLE NODES
ORDERLY SPREAD NONCONTIGUOUS
SPREAD
RARE – WALDEYER/
MESENTERI...
 Reed-Sternberg present
◦ Derived from germinal center or post germinal
center B cells
 Background of Reactive Inflammat...
 Account for 0.7% of new Ca in USA
 Arise in a Single or Chains of LN
 Most common Malignancy in YOUNG
ADULTS ( 32y/o)
...
 Unknown
 EBV plays a role  50% present in
R-S cells (Mixed Cellularity)
 High incidence  Hx of IM
 Genetic Suscepti...
 EBV (+) RS EXPRESS LATENT
MEMBRANE PROTEIN-1
◦ PROTEIN ENCODED BY EBV
◦ HAS TRANSFORMING ACTIVITY
◦ UPREGULATES NF- Kb
...
 ACTIVATION OF NF-kB RESCUES
DOOMED CELLS FROM APOPTOSIS
 RS cell PRODUCE CYTOKINE 
ACCUM. REACTIVE CELLS  SUPPORT
GR...
Predictable
Spread 1st to Contiguous
Nodes
◦Nodal Disease First  Spleen
 Liver  BM  Extranodal
 Soft to hard , large Lymph Node
 Nodularity common in Nodular
Sclerosis
 Foci of necrosis +
 Heterogenous c/s except ...
 PAINLESS LYMPHADENOPATHY
 PAIN INVOLVED L.N. W/ ALCOHOL
◦ Paraneoplastic Symptom
 CUTANEOUS ANERGY
◦ Depressed Cellula...
STAGE CRITERIA
I In one lymph node only
II In 2 or more LN on same side of the diaphragm
III In the Lymph nodes, Spleen, o...
Stage I or II Stage III or IV
Systemic
s/s
Usually
absent
Usually
present
Type Nodular
sclerosis
MC or LD
5 year
disease
f...
 Tumor stage is most important Prognostic
Variable
◦ Not Histologic Type
◦ R/T to current Tx protocols
 Long term surviv...
 MOST COMMON 65-70%
 MALE = FEMALES
 ADOLESCENT & YOUNG
ADULTS
 EXCELLENT PROGNOSIS
 Stage 1 or 2
 LOWER CERVICAL ,
SUPRACLAVICULAR &
MEDIASTINAL L.N.
 RARELY ASSOC. EBV
 LACUNAR TYPE Abundant
 COLLAGEN BAND  NODULAR
 POLYMORPHOUS
BACKGROUND
 DXTIC RS CELLS LESS
FREQUENT
LACUNAR RS
 20-25 %
 MALES > FEMALES
 STRONGLY ASSOC. W/ EBV
 OLDER & YOUNG ADULTS ( BIPHASIC )
 > 50% PRESENT AS STAGE 3-4
acco...
FREQUENTLY SEE
MONONUCLEAR &
DXTIC RS CELLS
DXTIC RS CELLS
Are numerousMONONUCLEAR
 UNCOMMON
 M>F
 OLDER ADULTS
 FREQUENT MONONUCLEAR AND DXTIC
R-S CELLS
◦ REACTIVE T LYMPHOS PREDOMINATES
 40% EBV ASS...
 5% OF CASES , UNCOMMON
 MALES > FEMALES ( < 35 y/o )
◦ Asymptomatic YOUNG MALES WITH
CERVICAL OR AXILLARY
LYMPHADENOPAT...
 NODULAR PATTERN DUE TO
EXPANDED B-CELL FOLLICLES
◦ POPULATED BY L&H CELLS AND REACTIVE
B-CELL
◦ DXTIC RS DIFFICULT TO FI...
POPCORN RS CELLS
L & H variants
NUMEROUS MATURE
LYMPHOCYTES
 <5 % LEAST COMMON
 OFTEN ASSOC. EBV
 COMMON
* OLDER PTS.
* HIV
* NON-INDUSTRIALIZED COUNTRIES
 SYSTEMIC SYMPTOMS
 PR...
Part 3 hodgkins  lymphoma
Part 3 hodgkins  lymphoma
Part 3 hodgkins  lymphoma
Part 3 hodgkins  lymphoma
Part 3 hodgkins  lymphoma
Part 3 hodgkins  lymphoma
Part 3 hodgkins  lymphoma
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Part 3 hodgkins lymphoma

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Part 3 hodgkins lymphoma

  1. 1. HODGKINS NON-HODGKINS OFTEN LOCALIZED LESION MULTIPLE NODES ORDERLY SPREAD NONCONTIGUOUS SPREAD RARE – WALDEYER/ MESENTERIC NODES COMMON UNCOMMON EXTRANODAL COMMON EXTRANODAL
  2. 2.  Reed-Sternberg present ◦ Derived from germinal center or post germinal center B cells  Background of Reactive Inflammatory Cells of Various types  Variable Fibrosis * LACK THE MONOMORPHIC APPEARANCE OF OTHER LYMPHOMA
  3. 3.  Account for 0.7% of new Ca in USA  Arise in a Single or Chains of LN  Most common Malignancy in YOUNG ADULTS ( 32y/o)  Curable in most cases  May progress to NHL or Leukemia ◦ spontaneously or after Tx.
  4. 4.  Unknown  EBV plays a role  50% present in R-S cells (Mixed Cellularity)  High incidence  Hx of IM  Genetic Susceptibility
  5. 5.  EBV (+) RS EXPRESS LATENT MEMBRANE PROTEIN-1 ◦ PROTEIN ENCODED BY EBV ◦ HAS TRANSFORMING ACTIVITY ◦ UPREGULATES NF- Kb  EBV (-) RS cells ◦ ACQUIRED MUTATION OF NEGATIVE REGULATOR OF NF-kB
  6. 6.  ACTIVATION OF NF-kB RESCUES DOOMED CELLS FROM APOPTOSIS  RS cell PRODUCE CYTOKINE  ACCUM. REACTIVE CELLS  SUPPORT GROWTH & SURVIVAL OF TUMOR CELLS ◦ IL-5, IL-6, IL-13 ,TNF
  7. 7. Predictable Spread 1st to Contiguous Nodes ◦Nodal Disease First  Spleen  Liver  BM  Extranodal
  8. 8.  Soft to hard , large Lymph Node  Nodularity common in Nodular Sclerosis  Foci of necrosis +  Heterogenous c/s except for LYMPHOCYTE PREDOMINANCE  Matted L.N. in Advanced cases
  9. 9.  PAINLESS LYMPHADENOPATHY  PAIN INVOLVED L.N. W/ ALCOHOL ◦ Paraneoplastic Symptom  CUTANEOUS ANERGY ◦ Depressed Cellular immunity  IMMUNE DYSFUNCTION ◦ UNKNOWN, PERSIST AFTER Tx.  INCREASED RISK FOR 2ND CANCERS ◦ AML, BREAST Ca GASTRIC Ca  Limited Disease is Cured w/ Local RadioTx
  10. 10. STAGE CRITERIA I In one lymph node only II In 2 or more LN on same side of the diaphragm III In the Lymph nodes, Spleen, or Both AND on Both sides of the diaphragm 1 Above the renal vessels (eg. Spleen, splenic, hilar, celiac, portal nodes 2 In the lower abdomen ( periaortic, pelvic, or imguinal nodes ) IV Extranodal involvement ( eg. Bone marrow, Lung, Liver ) A – absence of Systemic manifestation B – presence of Systemic manifestation NIGHT SWEATS, FEVER, WEIGHT LOSS
  11. 11. Stage I or II Stage III or IV Systemic s/s Usually absent Usually present Type Nodular sclerosis MC or LD 5 year disease free 90% 60-70% Systemic manifestation: NIGHT SWEATS, FEVER, WEIGHT LOSS
  12. 12.  Tumor stage is most important Prognostic Variable ◦ Not Histologic Type ◦ R/T to current Tx protocols  Long term survivors of ChemoTx and RadioTx ◦ Increased risk fro secondary Ca ◦ Breast Ca common in:  Females Tx w/ RadioTx to chest during adolescence ◦ AML/ Myelodysplastic syndrome common  ChemoTx
  13. 13.  MOST COMMON 65-70%  MALE = FEMALES  ADOLESCENT & YOUNG ADULTS  EXCELLENT PROGNOSIS
  14. 14.  Stage 1 or 2  LOWER CERVICAL , SUPRACLAVICULAR & MEDIASTINAL L.N.  RARELY ASSOC. EBV
  15. 15.  LACUNAR TYPE Abundant  COLLAGEN BAND  NODULAR  POLYMORPHOUS BACKGROUND  DXTIC RS CELLS LESS FREQUENT
  16. 16. LACUNAR RS
  17. 17.  20-25 %  MALES > FEMALES  STRONGLY ASSOC. W/ EBV  OLDER & YOUNG ADULTS ( BIPHASIC )  > 50% PRESENT AS STAGE 3-4 accompanied by SYSTEMIC SYMPTOMS Prognosis Very Good
  18. 18. FREQUENTLY SEE MONONUCLEAR & DXTIC RS CELLS DXTIC RS CELLS Are numerousMONONUCLEAR
  19. 19.  UNCOMMON  M>F  OLDER ADULTS  FREQUENT MONONUCLEAR AND DXTIC R-S CELLS ◦ REACTIVE T LYMPHOS PREDOMINATES  40% EBV ASSOC.  PROGNOSIS EXCELLENT
  20. 20.  5% OF CASES , UNCOMMON  MALES > FEMALES ( < 35 y/o ) ◦ Asymptomatic YOUNG MALES WITH CERVICAL OR AXILLARY LYMPHADENOPATHY ◦ MEDIASTINAL INVOLVEMENT IS RARE  NOT ASSOC. W/ EBV  PROGNOSIS EXCELLENT
  21. 21.  NODULAR PATTERN DUE TO EXPANDED B-CELL FOLLICLES ◦ POPULATED BY L&H CELLS AND REACTIVE B-CELL ◦ DXTIC RS DIFFICULT TO FIND  3-5% PROGRESS  DIFFUSE LARGE CELL
  22. 22. POPCORN RS CELLS L & H variants NUMEROUS MATURE LYMPHOCYTES
  23. 23.  <5 % LEAST COMMON  OFTEN ASSOC. EBV  COMMON * OLDER PTS. * HIV * NON-INDUSTRIALIZED COUNTRIES  SYSTEMIC SYMPTOMS  PRESENT AS ADVANCED STAGE  PROGNOSIS LESS FAVORABLE

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