Hodgkin lymphoma is a type of lymphoma characterized by the presence of Reed-Sternberg cells. It was first described in 1832 and can now be successfully treated with radiation or chemotherapy. The malignant cell is a B cell that has lost expression of normal B cell markers. Molecular changes contribute to uncontrolled growth and proliferation. Risk factors include EBV infection, HIV, and family history. Histologically, Reed-Sternberg cells are identified within an inflammatory background. Staging involves PET scans, bone marrow biopsy, and the Ann Arbor system. Treatment involves chemotherapy such as ABVD or radiation therapy to involved fields.
This document provides information about rectal prolapse including its anatomy, causes, clinical presentation, and surgical treatment options. It begins with a description of the rectal anatomy including its blood supply, lymphatic drainage, and curves. It then discusses the causes and types of rectal prolapse and explains how factors like pelvic floor weakness can lead to its development. Common signs and symptoms are outlined. Both perineal and abdominal surgical approaches are described in detail including the Thiersch, Delorme, Altemeier, and Wells procedures. Postoperative care is also reviewed. The document provides a comprehensive overview of rectal prolapse.
This document summarizes the portal circulation system and portal hypertension. It describes how blood flows from capillaries to the portal vein and to the liver before returning to systemic circulation. It then explains what causes portal hypertension, including liver cirrhosis and portal vein thrombosis. Finally, it discusses various treatment options for complications of portal hypertension like esophageal varices, including band ligation, sclerotherapy, portosystemic shunts, and TIPSS procedures.
The document describes the anatomy of the larynx. It covers the development, skeletal framework including cartilages, subdivisions, muscles, histology, blood supply, nerve supply, lymphatic drainage and applied anatomy of the larynx. Key points include the cartilages that make up the skeletal framework, the intrinsic and extrinsic muscles that control movement and phonation, the nerve and blood supply, and common congenital anomalies and pathologies of the larynx.
Blood supply and lymphatic drainage of stomachMonitoshPaul
The document summarizes the blood supply and lymphatic drainage of the stomach. It discusses the arterial supply from branches like the left gastric, right gastric, and gastroepiploic arteries. It also discusses the venous drainage which parallels the arterial supply. The lymphatic drainage is described through 4 zones that primarily drain to the celiac nodes. The document provides surgical importance for preserving certain vessels and ligating others in procedures like gastrectomy and splenectomy.
The document provides details on the anatomy, physiology, and clinical examination of the thyroid gland. It describes the location, shape, lobes, blood supply, nerve supply, lymphatic drainage, and development of the thyroid gland. It also discusses the endocrine function of producing thyroid hormones, the synthesis and secretion process, and factors involved in history taking and physical examination for thyroid disorders.
This document provides information about salivary glands, including their classification, anatomy, development, histology, and distinguishing characteristics. It discusses the major salivary glands - parotid, submandibular, and sublingual glands - describing their location, structure, blood supply, innervation and secretions. It also covers the minor salivary glands and compares the histological differences between serous and mucous acinar cells. In summary, it is a comprehensive overview of the salivary glands covering their anatomy, histology, development and functions.
The document discusses the anatomy of the tonsils and oropharynx. It describes the location and structures of the oropharynx, including the soft palate, palatoglossal arch, and palatopharyngeal arch. It then discusses the four main tonsil groups - the palatine, adenoid, tubal, and lingual tonsils - which make up Waldeyer's ring. Specifically, it describes the location of the palatine tonsils between the palatoglossal and palatopharyngeal arches, and their blood supply, nerve innervation, and histological structure.
This document provides information about rectal prolapse including its anatomy, causes, clinical presentation, and surgical treatment options. It begins with a description of the rectal anatomy including its blood supply, lymphatic drainage, and curves. It then discusses the causes and types of rectal prolapse and explains how factors like pelvic floor weakness can lead to its development. Common signs and symptoms are outlined. Both perineal and abdominal surgical approaches are described in detail including the Thiersch, Delorme, Altemeier, and Wells procedures. Postoperative care is also reviewed. The document provides a comprehensive overview of rectal prolapse.
This document summarizes the portal circulation system and portal hypertension. It describes how blood flows from capillaries to the portal vein and to the liver before returning to systemic circulation. It then explains what causes portal hypertension, including liver cirrhosis and portal vein thrombosis. Finally, it discusses various treatment options for complications of portal hypertension like esophageal varices, including band ligation, sclerotherapy, portosystemic shunts, and TIPSS procedures.
The document describes the anatomy of the larynx. It covers the development, skeletal framework including cartilages, subdivisions, muscles, histology, blood supply, nerve supply, lymphatic drainage and applied anatomy of the larynx. Key points include the cartilages that make up the skeletal framework, the intrinsic and extrinsic muscles that control movement and phonation, the nerve and blood supply, and common congenital anomalies and pathologies of the larynx.
Blood supply and lymphatic drainage of stomachMonitoshPaul
The document summarizes the blood supply and lymphatic drainage of the stomach. It discusses the arterial supply from branches like the left gastric, right gastric, and gastroepiploic arteries. It also discusses the venous drainage which parallels the arterial supply. The lymphatic drainage is described through 4 zones that primarily drain to the celiac nodes. The document provides surgical importance for preserving certain vessels and ligating others in procedures like gastrectomy and splenectomy.
The document provides details on the anatomy, physiology, and clinical examination of the thyroid gland. It describes the location, shape, lobes, blood supply, nerve supply, lymphatic drainage, and development of the thyroid gland. It also discusses the endocrine function of producing thyroid hormones, the synthesis and secretion process, and factors involved in history taking and physical examination for thyroid disorders.
This document provides information about salivary glands, including their classification, anatomy, development, histology, and distinguishing characteristics. It discusses the major salivary glands - parotid, submandibular, and sublingual glands - describing their location, structure, blood supply, innervation and secretions. It also covers the minor salivary glands and compares the histological differences between serous and mucous acinar cells. In summary, it is a comprehensive overview of the salivary glands covering their anatomy, histology, development and functions.
The document discusses the anatomy of the tonsils and oropharynx. It describes the location and structures of the oropharynx, including the soft palate, palatoglossal arch, and palatopharyngeal arch. It then discusses the four main tonsil groups - the palatine, adenoid, tubal, and lingual tonsils - which make up Waldeyer's ring. Specifically, it describes the location of the palatine tonsils between the palatoglossal and palatopharyngeal arches, and their blood supply, nerve innervation, and histological structure.
The tongue develops from tissues originating in the pharyngeal arches and swellings in the floor of the mouth. It begins developing at 4 weeks as a tuberculum impar surrounded by two lateral lingual swellings that merge to form the anterior two-thirds of the tongue. The root develops from the hypobranchial eminence originating in the third arch. Muscles of the tongue originate from occipital somites and are innervated by the hypoglossal nerve. The anterior two-thirds receive innervation from the trigeminal nerve and the posterior third from the glossopharyngeal nerve. The tongue separates from the floor of the mouth and develops four types of lingual papillae
C:\Documents And Settings\User\Desktop\Stomach HistologyMBBS IMS MSU
The document describes the histology of the stomach, including its four main layers (mucosa, submucosa, muscularis externa, and serosa) and the different cell types found within the gastric glands of the mucosa, such as parietal, chief, and mucus secreting cells. It also explains the distinct histological features of the different regions of the stomach, like the branched glands that open into deep pits in the pyloric region. The lamina propria layer contains blood vessels, nerves, lymphatics, and smooth muscle cells that support the overlying mucosa.
The tongue develops from two parts - the anterior 2/3 forms from lateral lingual swellings that merge at the tuberculum impar, while the posterior 1/3 forms from the copula and hypobrachial eminence. The anterior 2/3 is innervated by the trigeminal nerve and the posterior 1/3 by the glossopharyngeal nerve. Common abnormalities of the tongue include microglossia (abnormally small tongue), macroglossia (abnormally large tongue), ankyloglossia (tongue tie), cleft tongue, and fissured tongue. These conditions can affect speech, swallowing, and dental development.
The document provides information on the digestive system. It discusses the different parts of the digestive system including the oral cavity, esophagus, stomach, and small intestine. It describes the histological layers common to the tubular organs of the digestive system, including the mucosa, submucosa, muscularis, and serosa/adventitia. It also provides details on the microscopic structure and functions of the various glands and tissues within these organs.
The liver develops from the endoderm of the foregut. During the 4th week, the hepatic diverticulum buds off from the foregut and divides into the pars hepatica and pars cystica. The pars hepatica gives rise to the liver parenchyma of hepatocytes and bile ducts. It expands between the layers of the septum transversum mesenchyme. The pars cystica develops into the gallbladder and cystic duct. By week 8, the basic structure of the liver and biliary tree is established.
Thyroid surgery and mangement protocols.pptxPradeep Pande
This document provides tips and instructions for using a PowerPoint presentation on thyroid disorders and their management. It discusses how to structure the presentation as an active learning session by showing blank slides to elicit student responses before providing content. The presentation covers topics like the anatomy of the thyroid gland, types of thyroid disorders and their presentations, various surgical approaches and techniques for thyroidectomy, complications, and post-operative management of thyroid cancer.
In this presentation the development of Small intestine and Pancreas has been discussed. The viewer would be able to understand the concept of physiological herniation and rotation of the Primary intestinal loop with in the connecting stalk.
Lymph nodes are oval structures that filter lymph and help the immune system fight infections. They contain a capsule that admits lymph through afferent vessels and releases it through efferent vessels. The lymph circulates through sinuses in the cortex and medulla before exiting. Lymph nodes vary in size and receive blood only at the hilum. They contain lymphatic tissue to combat pathogens by generating antibodies and immune cells that travel via efferent lymph vessels.
The stomach develops from the foregut as a simple tubular structure that enlarges dorsally through differential growth. It rotates along two axes, determining its final position in the left hypochondrium. The dorsal mesogastrium suspends the stomach and later forms the greater omentum. The duodenum develops from the foregut and midgut, forming a C-shaped loop that rotates to the right as the stomach rotates left. Both become retroperitoneal as their mesenteries fuse with the posterior abdominal wall.
The thyroid gland originates from endodermal cells on the midline pharyngeal floor between the 24th day of gestation. It initially develops caudal to the tuberculum impar from the 1st pharyngeal arch on the floor of the developing pharynx. The thyroid primordium starts as a simple midline thickening that forms the thyroid diverticulum. During descent, the thyroid gland forms its mature bilobed shape connected by an isthmus as it reaches its final location in the neck by the 7th gestational week. Parafollicular C cells are derived from the ultimobranchial body which fuses with the thyroid gland and disseminates its cells.
The thyroid gland develops from an endodermal thickening in the third week of gestation. It descends as the thyroglossal duct and bifurcates into two lobes connected by an isthmus. The gland is the first to become functionally active, synthesizing thyroid hormones through iodination of thyroglobulin. It is uniquely dependent on iodine from the external environment and has the ability to store hormones for later release.
The document summarizes the physiology of swallowing. It describes the three main phases - oral, pharyngeal, and esophageal. Key points include that swallowing requires coordinated muscle activity in the head and neck and involves passing food from the mouth to stomach. The oral phase prepares food for swallowing through chewing and tongue movement. In the pharyngeal phase, the airway is protected as food is pushed over the epiglottis. Swallowing is controlled by neural pathways from the cortex to brainstem and medulla. Respiration is suspended during swallowing to prevent aspiration.
The document discusses the portal circulation system and portal hypertension. The portal vein is formed by the union of the superior mesenteric vein and splenic vein. It carries deoxygenated blood from the digestive organs to the liver. Five sites in the body allow blood to flow between the portal and systemic circulation systems. Portal hypertension occurs when increased blood pressure in the portal vein is caused by liver cirrhosis or thrombosis. Consequences of portal hypertension include esophageal and hemorrhoidal varices, caput medusae, ascites, and splenomegaly. Treatment options consist of band ligation, sclerotherapy, portosystemic shunts, and TIPSS procedures.
colon anatomy, anatomy of large intestine, anatomy of large bowel, histology of large intestine, large intestine, histology, colon, appendices epiploica, taenia coli, haustrautions, ilio caecal valve
This document describes the anatomy and histology of the esophagus. It notes that the esophagus has four main layers: mucosa, submucosa, muscularis, and serosa/adventitia. The mucosa contains stratified squamous epithelium and esophageal glands. The submucosa contains dense connective tissue and esophageal glands. The muscularis externa contains both skeletal and smooth muscle fibers arranged in inner circular and outer longitudinal layers. Nerves that innervate the esophagus include the enteric nervous system and sympathetic and parasympathetic pathways.
This document describes the 7 levels of cervical lymph nodes in the neck. It provides details on the boundaries, drainage patterns, and involved pathology for each level. The levels extend from the skull base superiorly to the clavicle inferiorly. Each level contains specific nodal groups and may have sublevels. The document defines the clinical, radiologic, and surgical boundaries for each lymph node level to aid in neck dissection and evaluation of cervical lymphadenopathy.
This document summarizes different types of gastric polyps, including solitary and polyposis syndromes. It describes epithelial polyps such as fundic gland, hyperplastic, and adenomatous polyps. It also discusses non-mucosal intramural polyps and polyposis syndromes. Specific polyp types such as adenomatous, hyperplastic, fundic gland, and Peutz-Jeghers polyps are defined. New syndromes associated with gastric polyposis and cancer risk such as GAPPS are introduced. The classification, histology, genetic causes, and cancer associations of different polyp types are concisely summarized.
Anatomy of recurrent laryngeal nerveAnatomy of recurrent laryngeal nerveAnato...Ebtisam ~
The recurrent laryngeal nerve is a branch of the vagus nerve that supplies motor and sensory fibers to the larynx. There are right and left recurrent laryngeal nerves that arise from the vagus nerve but follow different courses. The right nerve curves around the subclavian artery while the left nerve crosses under the aortic arch, making it longer. Due to its longer course, the left recurrent laryngeal nerve is more susceptible to injury.
This document provides an overview of the embryology, anatomy, and physiology of the ureter. It discusses the embryonic development of the ureter from the ureteric bud. Anatomically, it describes the course, relations, blood supply, innervation, and sites of narrowing of the ureter. Physiologically, it explains the electrical and contractile properties of ureteral smooth muscle cells, the generation and propagation of action potentials, the role of neurotransmitters and second messengers in contraction, and the mechanical properties and pressure-length relationships of the ureter. The nervous system is noted to have a modulatory rather than essential role in ureteral peristalsis.
This document provides information on anal malignancies, including:
- Anal cancer is uncommon but incidence has increased, making up 4% of anorectal malignancies.
- The anal canal anatomy and blood supply are described. Risk factors for anal cancer include human papillomavirus infection, HIV/AIDS, immunosuppression, and smoking.
- Symptoms typically include rectal bleeding, pain, or masses. Evaluation involves examination, imaging, and biopsy. Treatment is usually chemoradiation, while surgery is reserved for residual or recurrent disease. Prognosis depends on stage and response to treatment.
BUS 890: Culminating Experience in Strategic Management, FALL 2010
The culminating project is an in-depth case analysis of Suntech Power Holdings Co., Ltd. The analysis includes multiple concepts from the course to help explain the strategies, actions and performance of the company.
The tongue develops from tissues originating in the pharyngeal arches and swellings in the floor of the mouth. It begins developing at 4 weeks as a tuberculum impar surrounded by two lateral lingual swellings that merge to form the anterior two-thirds of the tongue. The root develops from the hypobranchial eminence originating in the third arch. Muscles of the tongue originate from occipital somites and are innervated by the hypoglossal nerve. The anterior two-thirds receive innervation from the trigeminal nerve and the posterior third from the glossopharyngeal nerve. The tongue separates from the floor of the mouth and develops four types of lingual papillae
C:\Documents And Settings\User\Desktop\Stomach HistologyMBBS IMS MSU
The document describes the histology of the stomach, including its four main layers (mucosa, submucosa, muscularis externa, and serosa) and the different cell types found within the gastric glands of the mucosa, such as parietal, chief, and mucus secreting cells. It also explains the distinct histological features of the different regions of the stomach, like the branched glands that open into deep pits in the pyloric region. The lamina propria layer contains blood vessels, nerves, lymphatics, and smooth muscle cells that support the overlying mucosa.
The tongue develops from two parts - the anterior 2/3 forms from lateral lingual swellings that merge at the tuberculum impar, while the posterior 1/3 forms from the copula and hypobrachial eminence. The anterior 2/3 is innervated by the trigeminal nerve and the posterior 1/3 by the glossopharyngeal nerve. Common abnormalities of the tongue include microglossia (abnormally small tongue), macroglossia (abnormally large tongue), ankyloglossia (tongue tie), cleft tongue, and fissured tongue. These conditions can affect speech, swallowing, and dental development.
The document provides information on the digestive system. It discusses the different parts of the digestive system including the oral cavity, esophagus, stomach, and small intestine. It describes the histological layers common to the tubular organs of the digestive system, including the mucosa, submucosa, muscularis, and serosa/adventitia. It also provides details on the microscopic structure and functions of the various glands and tissues within these organs.
The liver develops from the endoderm of the foregut. During the 4th week, the hepatic diverticulum buds off from the foregut and divides into the pars hepatica and pars cystica. The pars hepatica gives rise to the liver parenchyma of hepatocytes and bile ducts. It expands between the layers of the septum transversum mesenchyme. The pars cystica develops into the gallbladder and cystic duct. By week 8, the basic structure of the liver and biliary tree is established.
Thyroid surgery and mangement protocols.pptxPradeep Pande
This document provides tips and instructions for using a PowerPoint presentation on thyroid disorders and their management. It discusses how to structure the presentation as an active learning session by showing blank slides to elicit student responses before providing content. The presentation covers topics like the anatomy of the thyroid gland, types of thyroid disorders and their presentations, various surgical approaches and techniques for thyroidectomy, complications, and post-operative management of thyroid cancer.
In this presentation the development of Small intestine and Pancreas has been discussed. The viewer would be able to understand the concept of physiological herniation and rotation of the Primary intestinal loop with in the connecting stalk.
Lymph nodes are oval structures that filter lymph and help the immune system fight infections. They contain a capsule that admits lymph through afferent vessels and releases it through efferent vessels. The lymph circulates through sinuses in the cortex and medulla before exiting. Lymph nodes vary in size and receive blood only at the hilum. They contain lymphatic tissue to combat pathogens by generating antibodies and immune cells that travel via efferent lymph vessels.
The stomach develops from the foregut as a simple tubular structure that enlarges dorsally through differential growth. It rotates along two axes, determining its final position in the left hypochondrium. The dorsal mesogastrium suspends the stomach and later forms the greater omentum. The duodenum develops from the foregut and midgut, forming a C-shaped loop that rotates to the right as the stomach rotates left. Both become retroperitoneal as their mesenteries fuse with the posterior abdominal wall.
The thyroid gland originates from endodermal cells on the midline pharyngeal floor between the 24th day of gestation. It initially develops caudal to the tuberculum impar from the 1st pharyngeal arch on the floor of the developing pharynx. The thyroid primordium starts as a simple midline thickening that forms the thyroid diverticulum. During descent, the thyroid gland forms its mature bilobed shape connected by an isthmus as it reaches its final location in the neck by the 7th gestational week. Parafollicular C cells are derived from the ultimobranchial body which fuses with the thyroid gland and disseminates its cells.
The thyroid gland develops from an endodermal thickening in the third week of gestation. It descends as the thyroglossal duct and bifurcates into two lobes connected by an isthmus. The gland is the first to become functionally active, synthesizing thyroid hormones through iodination of thyroglobulin. It is uniquely dependent on iodine from the external environment and has the ability to store hormones for later release.
The document summarizes the physiology of swallowing. It describes the three main phases - oral, pharyngeal, and esophageal. Key points include that swallowing requires coordinated muscle activity in the head and neck and involves passing food from the mouth to stomach. The oral phase prepares food for swallowing through chewing and tongue movement. In the pharyngeal phase, the airway is protected as food is pushed over the epiglottis. Swallowing is controlled by neural pathways from the cortex to brainstem and medulla. Respiration is suspended during swallowing to prevent aspiration.
The document discusses the portal circulation system and portal hypertension. The portal vein is formed by the union of the superior mesenteric vein and splenic vein. It carries deoxygenated blood from the digestive organs to the liver. Five sites in the body allow blood to flow between the portal and systemic circulation systems. Portal hypertension occurs when increased blood pressure in the portal vein is caused by liver cirrhosis or thrombosis. Consequences of portal hypertension include esophageal and hemorrhoidal varices, caput medusae, ascites, and splenomegaly. Treatment options consist of band ligation, sclerotherapy, portosystemic shunts, and TIPSS procedures.
colon anatomy, anatomy of large intestine, anatomy of large bowel, histology of large intestine, large intestine, histology, colon, appendices epiploica, taenia coli, haustrautions, ilio caecal valve
This document describes the anatomy and histology of the esophagus. It notes that the esophagus has four main layers: mucosa, submucosa, muscularis, and serosa/adventitia. The mucosa contains stratified squamous epithelium and esophageal glands. The submucosa contains dense connective tissue and esophageal glands. The muscularis externa contains both skeletal and smooth muscle fibers arranged in inner circular and outer longitudinal layers. Nerves that innervate the esophagus include the enteric nervous system and sympathetic and parasympathetic pathways.
This document describes the 7 levels of cervical lymph nodes in the neck. It provides details on the boundaries, drainage patterns, and involved pathology for each level. The levels extend from the skull base superiorly to the clavicle inferiorly. Each level contains specific nodal groups and may have sublevels. The document defines the clinical, radiologic, and surgical boundaries for each lymph node level to aid in neck dissection and evaluation of cervical lymphadenopathy.
This document summarizes different types of gastric polyps, including solitary and polyposis syndromes. It describes epithelial polyps such as fundic gland, hyperplastic, and adenomatous polyps. It also discusses non-mucosal intramural polyps and polyposis syndromes. Specific polyp types such as adenomatous, hyperplastic, fundic gland, and Peutz-Jeghers polyps are defined. New syndromes associated with gastric polyposis and cancer risk such as GAPPS are introduced. The classification, histology, genetic causes, and cancer associations of different polyp types are concisely summarized.
Anatomy of recurrent laryngeal nerveAnatomy of recurrent laryngeal nerveAnato...Ebtisam ~
The recurrent laryngeal nerve is a branch of the vagus nerve that supplies motor and sensory fibers to the larynx. There are right and left recurrent laryngeal nerves that arise from the vagus nerve but follow different courses. The right nerve curves around the subclavian artery while the left nerve crosses under the aortic arch, making it longer. Due to its longer course, the left recurrent laryngeal nerve is more susceptible to injury.
This document provides an overview of the embryology, anatomy, and physiology of the ureter. It discusses the embryonic development of the ureter from the ureteric bud. Anatomically, it describes the course, relations, blood supply, innervation, and sites of narrowing of the ureter. Physiologically, it explains the electrical and contractile properties of ureteral smooth muscle cells, the generation and propagation of action potentials, the role of neurotransmitters and second messengers in contraction, and the mechanical properties and pressure-length relationships of the ureter. The nervous system is noted to have a modulatory rather than essential role in ureteral peristalsis.
This document provides information on anal malignancies, including:
- Anal cancer is uncommon but incidence has increased, making up 4% of anorectal malignancies.
- The anal canal anatomy and blood supply are described. Risk factors for anal cancer include human papillomavirus infection, HIV/AIDS, immunosuppression, and smoking.
- Symptoms typically include rectal bleeding, pain, or masses. Evaluation involves examination, imaging, and biopsy. Treatment is usually chemoradiation, while surgery is reserved for residual or recurrent disease. Prognosis depends on stage and response to treatment.
BUS 890: Culminating Experience in Strategic Management, FALL 2010
The culminating project is an in-depth case analysis of Suntech Power Holdings Co., Ltd. The analysis includes multiple concepts from the course to help explain the strategies, actions and performance of the company.
My team and I created a strategic analysis of Samsung USA for our senior capstone project in regard the evolution of home entertainment in the smart home industry.
The document provides an analysis of the macroenvironment and industry for Lufthansa, a large German aviation group. It begins with an overview of Lufthansa's business segments and financial information. It then analyzes the political, economic, social, technological, environmental, and legal factors affecting Lufthansa internationally and within the airline industry. These PESTEL factors are assessed to understand opportunities and threats in the external environment.
Porsche has traditionally positioned itself as an exclusive, high-performance sports car brand. However, several factors in recent years impacted Porsche's business performance, including the 2008 recession, increased costs, and stringent emission standards. In response, Porsche introduced new models like the Cayenne SUV and Panamera to broaden its appeal. It also formed a strategic alliance with Volkswagen to share technology and innovation. Porsche's marketing strategy shifted to target younger consumers and emphasize the practical aspects and fuel efficiency of its vehicles to better align with changing American consumer values. This led to increased sales success in the North American market. The recommendation proposes further targeting younger demographics, increasing product placement, and highlighting Porsche's fuel efficiency to
Sony is a Japanese conglomerate founded in 1946 with over 140,000 employees globally. The document provides an overview of Sony's vision, mission, core values, and value chain analysis. It then discusses Porter's five forces analysis, including high intensity competitive rivalry and threat of substitute products. A SWOT analysis identifies Sony's strengths in innovation and brand strength but weaknesses in product pricing. The document concludes with a competitive advantage discussion of Sony's history of innovation.
This PowerPoint examines the corporate structure of Target in a strategic manor. See how it compares to its competitors and why it is one of the leading retailers in today's society.
Strategic Analysis of Nucor Steel Industry in 2010Mayank Goyal
Strategic Analysis of one of America's leading Steel Giant Nucor. This strategic analysis presents: 1. Porter's Five Forces to determine the Steel Industry in USA market. 2. PESTEL framework to understand the Political, Economical, Social, Technological, Environmental and Legal challenges faced by Nucor in 2010. 3. SWOT analysis to understand the Strengths, Weakness, Opportunities and Threats for Nucor. 4. Value Chain Analysis to understand the internal and external business analysis for Nucor. The analysis is followed by summarizing Problems and Issues of Nucor in 2010. This is further followed by a detailed recommendation for adoption of the right strategic-fit for Nucor to conquer and invade the market back again in the USA.
1. Culture methods are used to isolate bacteria in pure culture, demonstrate their properties, obtain sufficient growth for tests, and maintain stock cultures.
2. Common culture methods include streak culture, lawn culture, stroke culture, stab culture, pour plate culture, and liquid culture.
3. Special methods like anaerobic culture techniques are needed to isolate and grow anaerobic bacteria in the absence of oxygen using methods that generate hydrogen and carbon dioxide gases.
What is Lymphoma?
Malignant lymphoma is a term given to tumors of the lymphoid system and specifically of lymphocytes and their precursor cells
i.e.
Cancer of the lymphatic system.
Many lymphomas are known to be due to specific genetic mutations.
Lymphomas are primary malignancies of lymph nodes and the peripheral lymphatics.
Neoplastic proliferative process of the lymphopoietic portion of the lymphoid system that involves cells of either the lymphocytic or histiocytic series in varying degrees of differentiation & occurs in an essentially homogenous population of a single cell type.
The first lymphoma type recognised was by Dr Thomas Hodgkin in 1832. In 1865 Dr Samuel Wilks recognised additional cases, rediscovered the report by Hodgkin, and designated this neoplasm as ‘Hodgkin disease’.
Hodgkin lymphoma (HL) represents about 10% of all lymphomas.
HL is distinct from other non-Hodgkin lymphomas, clinically by the contiguous spread of tumour along the lymphoid system, and morphologically by the presence of a spectrum of neoplastic cells, including mononuclear Hodgkin (H) cells, classic multinucleated Reed–Sternberg (RS) cells, and mummified (degenerating) cells against an inflammatory background.
The background inflammatory cells actively attracted by HL tumour cells may include T cells, B cells, histiocytes, plasma cells, neutrophils, eosinophils and mast cells.
The etiology of HD is unknown. Infectious agents, especially the Epstein-Barr virus (EBV), may be involved in the pathogenesis.
In as many as 50% of HD cases, the tumor cells are EBV-positive. EBV positivity is higher with mixed cellularity Hodgkin disease (60–70%) than the nodular sclerosis Hodgkin disease (15–30%).
Epstein–Barr virus (EBV), also called human herpes virus 4 (HHV-4), is a member of the herpes family and is one of the most common viruses in humans.
In immunocompetent hosts, EBV-infected B cells are in a resting state under host T-cell immune surveillance.
In hosts with immune dysfunction, EBV-infected cells in the reservoir may be reactivated and proliferate.
In EBV-infected cells, based on the viral proteins expressed, three latency transcription programs of EBV are designated: growth program (latency III) with expression of EBV nuclear antigens 1–6 (EBNA1-6), latent membrane proteins (LMP1, 2A and 2B); default program (latency II) expressing EBNA1, LMP1 and LMP2A; and latency program (latency I), with none or only expression of LMP2A.
In EBV-positive cases, usually all HRS cells are positive, indicating that the infection was an early event in lymphoma development.
The EBV+ HRS cells typically show an EBV latency II gene expression profile, meaning expression of the viral proteins EBV nuclear antigen 1 (EBNA1) and latent membrane proteins 1 and 2a (LMP1 and LMP2a).
EBNA1 is essential for replication of the episomal viral genome in proliferating cells. LMP1 mimics an active CD40 receptor and hence stimulates NF- B and PI3K/AKT activity.
As BCR and CD40 signalling are main survival signals for GC B cells, EBV infection of GC B cells may be a way how GC B cells with destructive mutations survive and become HRS precursor cells.
Hodgkin's lymphoma is characterized by the presence of Reed-Sternberg cells. It is classified into five subtypes based on the microscopic appearance of the malignant cells and reactive cells present. The subtypes include nodular sclerosis, mixed cellularity, lymphocyte-rich, lymphocyte depletion, and lymphocyte predominance. Reed-Sternberg cells have origins from B cells but fail to express most B cell markers. Diagnosis involves lymph node biopsy and staging involves imaging and laboratory tests to determine extent of disease.
Lymphoma is a cancer of lymphocytes. The most common place for abnormal lymphocytes is in lymph nodes (glands) particularly
under the arms, in the neck and in the groin.
Lymphoma is solid tumors of the immune system arising from cells of lymphoid tissues; lymphocytes, histiocytes, and reticulum cells. It can happen anywhere in the immune system, but usually in lymph nodes, spleen, marrow, and tonsils. Location and the behavior of lymphomas separate them from leukemia.The malignancy starts and restricted to lymphoid tissues and progress to involve the BM and appears in PB, at this stage it may be named, “lymphosarcoma cell leukemia.
Lymphomas are the third most common childhood malignancy. Hodgkin lymphoma is characterized by Reed-Sternberg cells and is diagnosed via biopsy. Treatment involves chemotherapy, with regimens depending on risk stratification. Non-Hodgkin lymphoma subtypes include Burkitt lymphoma and lymphoblastic lymphoma. Staging guides treatment, which typically has high survival rates. Wilms tumor arises from nephrogenic rests and presents as an abdominal mass. Staging and histology guide surgery and chemotherapy according to national protocols, with high cure rates.
This document provides an overview of Hodgkin lymphoma, including its normal structure and histology, WHO classification, and subtypes. It discusses the pathogenesis and epidemiology of Hodgkin lymphoma, describing the four main subtypes of classical Hodgkin lymphoma and nodular lymphocyte predominant Hodgkin lymphoma. Key features of each subtype are summarized, along with diagnostic criteria and differential diagnoses. Prognosis and management are also briefly covered.
Hodgkin's lymphoma, also known as Hodgkin's disease, is a cancer that originates in the lymphatic system. It is characterized by the presence of Reed-Sternberg cells in the lymph nodes and other tissues. The disease has four main subtypes - nodular sclerosis, mixed cellularity, lymphocyte depletion, and lymphocyte rich - which are distinguished based on the type of cells in the tissue around the Reed-Sternberg cells. The nodular sclerosis subtype, which involves bands of fibrosis dividing the lymph node tissue into nodules, accounts for about 40-70% of cases. Hodgkin's lymphoma most commonly presents with painless swelling of lymph nodes in the neck,
This document discusses lymphoid neoplasms and lymphomas. It begins by describing lymphomas as a diverse group of lympho-reticular neoplasms that can present as lymphocytic leukemia or lymphoma. The WHO classification sorts lymphoid neoplasms into categories including precursor B-cell and T-cell neoplasms and mature B-cell and T-cell neoplasms. Hodgkin's lymphoma and non-Hodgkin's lymphoma are described in more detail, including subtypes, cell types, immunophenotypes, and characteristics. Burkitt's lymphoma is also summarized as a type of non-Hodgkin's lymphoma that can present in endemic, sporadic, or
The document summarizes recent advances in Hodgkin's lymphoma. It discusses the history and classification of Hodgkin's lymphoma. It covers immunophenotype markers, involvement of Epstein-Barr virus, genetic changes in Hodgkin-Reed-Sternberg cells, the tumor microenvironment, microRNAs, and mechanisms of chemoresistance. Novel therapies discussed include monoclonal antibodies targeting CD20 and CD30.
Hodgkins lymphoma pathogenesis and targets for therapyJan-Gert Nel
Hodgkin's lymphoma has progressed greatly in treatment since the mid-20th century with radiotherapy and chemotherapy. However, these treatments carry late toxicities. The pathogenesis of Hodgkin's lymphoma involves constitutive NF-kB activation in Reed-Sternberg cells, which promotes resistance to apoptosis. Epstein-Barr virus association varies by subtype and epidemiological factors. Emerging biologically-based treatment strategies target pathways like NF-kB, CD30, and the proteasome to induce apoptosis in Reed-Sternberg cells.
The document provides an overview of lymphoma, including its epidemiology, classification, clinical presentation, diagnosis, staging, and treatment. It discusses key types such as Hodgkin lymphoma and diffuse large B-cell lymphoma. Hodgkin lymphoma is characterized by Reed-Sternberg cells and has several histologic subtypes. Staging involves evaluating disease extent through imaging and bone marrow biopsy. Treatment may involve chemotherapy, radiation therapy, or a combination depending on the stage and subtype. Prognosis and long-term effects of treatment are also reviewed.
Hodgkin Lymphoma is a type of lymphoma that is highly curable. It most commonly affects young adults and presents with slow growing lymph node enlargement. There are two main types - classical Hodgkin lymphoma and nodular lymphocyte predominant Hodgkin lymphoma. Treatment involves chemotherapy, with or without radiation therapy, depending on the stage and risk factors. Prognosis and treatment are determined by staging tests and prognostic scoring systems. New treatments involving immunotherapy are showing promise for relapsed or refractory cases.
REFERENCES
cancer.org | 1.800.227.2345
Advances in the diagnosis and management
of lymphoma
Zachary H Word1
Matthew J Matasar1,2
1
Lymphoma Service, Department of
Medicine, Memorial Sloan–Kettering
Cancer Center, 2
Department of
Medicine, New York Presbyterian
Hospital, New York, NY, USA
Correspondence: Matthew J Matasar
Memorial Sloan–Kettering Cancer Center,
1275 York Avenue, New York,
NY 10065, USA
Tel +1 212 639 8889
Fax +1 646 422 2291
Email matasarm@mskcc.org
Lymphoma and CLL Forms
Parameswaran Hari, MD, MS
CLymphoma 101: The Basics
Neha Mehta-Shah, MD, MSCI
Assistant Professor
Department of Medicine
Division of Oncology
IBMTR , Milwaukee
Hodgkin lymphoma is a type of lymphoma characterized by the presence of Reed-Sternberg cells. It was first described in the 1800s and has several subtypes classified based on the appearance of cells under microscopy. The cause is largely unknown but Epstein-Barr virus is thought to play a role in some cases. Reed-Sternberg cells are large abnormal cells that are used to diagnose Hodgkin lymphoma. Clinical features include enlarged lymph nodes and systemic symptoms. Staging involves the Ann Arbor system and treatment is typically chemotherapy, radiation, or both.
Mr. Salim, a 62-year-old man, presented with right neck and left groin swelling for 3 months along with 7-8 kg of weight loss. Biopsy revealed diffuse large B-cell non-Hodgkin lymphoma (NHL). He was diagnosed with stage IV NHL and treated with rituximab and CHOP chemotherapy. The presentation discusses lymphadenopathy causes, lymphoma types and differences between Hodgkin and non-Hodgkin lymphomas, risk factors, investigations and treatments. Key points include distinguishing reactive from tumoral lymph nodes, indolent versus aggressive NHL subtypes, common genetic abnormalities in lymphomas, and involvement of Epstein-Barr virus in certain malignancies.
Hodgkin's lymphoma, also known as Hodgkin's disease, is a type of lymphoma characterized by the presence of Reed-Sternberg cells. It most commonly presents as a slowly expanding lymph node in the neck, underarms, or groin. There are four main subtypes classified by the type of cells in the background tissue. Treatment involves chemotherapy, radiation therapy, or both, with prognosis depending on stage and tumor burden rather than histological subtype.
Hodgkin's lymphoma is a cancer of the lymphatic system that is characterized by the presence of Reed-Sternberg cells. There are two main types: classical Hodgkin's lymphoma and nodular lymphocyte predominant Hodgkin's lymphoma. Classical Hodgkin's lymphoma is further divided into subtypes based on the cellular background and presence of fibrosis, including nodular sclerosis, mixed cellularity, lymphocyte rich, and lymphocyte depleted. The cause is unknown but Epstein-Barr virus infection plays a role in some cases. Diagnosis involves identifying Reed-Sternberg cells on biopsy.
1. Hodgkin lymphoma is a cancer of the lymphatic system characterized by the presence of Reed-Sternberg cells. It is diagnosed through biopsy of affected lymph nodes.
2. Signs and symptoms may include enlarged lymph nodes, fever, night sweats, and weight loss. The disease is typically divided into early and advanced stages to guide treatment.
3. Treatment involves chemotherapy, often combined with radiation therapy. Common chemotherapy regimens include MOPP and ABVD. The treatment approach depends on disease stage and other risk factors.
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End-tidal carbon dioxide (ETCO2) is the level of carbon dioxide that is released at the end of an exhaled breath. ETCO2 levels reflect the adequacy with which carbon dioxide (CO2) is carried in the blood back to the lungs and exhaled.
Non-invasive methods for ETCO2 measurement include capnometry and capnography. Capnometry provides a numerical value for ETCO2. In contrast, capnography delivers a more comprehensive measurement that is displayed in both graphical (waveform) and numerical form.
Sidestream devices can monitor both intubated and non-intubated patients, while mainstream devices are most often limited to intubated patients.
NURSING MANAGEMENT OF PATIENT WITH EMPHYSEMA .PPTblessyjannu21
Prepared by Prof. BLESSY THOMAS, VICE PRINCIPAL, FNCON, SPN.
Emphysema is a disease condition of respiratory system.
Emphysema is an abnormal permanent enlargement of the air spaces distal to terminal bronchioles, accompanied by destruction of their walls and without obvious fibrosis.
Emphysema of lung is defined as hyper inflation of the lung ais spaces due to obstruction of non respiratory bronchioles as due to loss of elasticity of alveoli.
It is a type of chronic obstructive
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It is a progressive disease of lungs.
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Pneumothorax, also known as a collapsed lung, is a condition that occurs when air leaks into the space between the lung and chest wall. This air buildup puts pressure on the lung, preventing it from expanding fully when you breathe. A pneumothorax can cause a complete or partial collapse of the lung.
3. • It was named after Thomas Hodgkin who first
described it in 1832.
• Dorothy Reed and Carl Sternberg first described the
malignant cells of Hodgkin lymphoma call Reed
Sternberg cells.
• Hodgkin lymphoma was the first cancer which could
be successfully treated by radiation therapy and also
by combination chemotherapy
• Hodgkin lymphoma (HL) is a aggressive B-cell
lymphoma.
INTRODUCTION
4. Hodgkin disease
Hodgkin lymphoma
Type of malignant lymphoma in which Reed-Sternberg cells are present in
a characterstic background of reactive inflammatory cells of various types,
accompanied by fibrosis of variable degree.
( except NLPHL)
4
6. Pathogenesis
Cell of origin
The malignant lymphocyte in cHL is known as the Hodgkin
and Reed–Sternberg (HRS) cell.
• The demonstration of clonal rearrangements of the
immunoglobulin heavy- and light-chain loci has
confirmed their B-cell origin.
• Furthermore, the presence of somatic hypermutation
within the immunoglobulin heavy and light chain loci
suggest that HRS cell are derived from B lymphocytes.
7.
8. So why they do not have typical B cell
marker???
• HRS cells have lost most of the
normal B-cell lineage gene
expression program through
numerous aberrant genetic
mechanisms, such as genetic
silencing at B-cell gene promoter
regions.
9. MOLECULAR PATHOGENESIS
Genes involved in normal B-lymphocyte growth and
differentiation are suppressed in HRS cells.
Signalling pathways contribute to the malignant
phenotype of HRS cells including the following:
1. HRS cells show constitutive activation of the NF-κB
pathway, which is associated with apoptosis resistance.
2. The JAK-STAT signalling pathway is overactive in HRS
cells, resulting in uncontrolled growth and proliferation.
Mechanisms of JAK-STAT over-activity include
chromosomal gains.
10. 3 HRS cells have been shown to have
deacetylated histones (H3), increased
H3K27 trimethylation and DNA
methylation patterns, leading to silencing
of tumor-suppressor genes and the
extinction of the normal B-lymphocyte
expression profile.
4 Mutations in β2M(house keeping gene)
11. ROLE OF EBV
This likely represents a mechanism by
which the HRS cell bypasses the need for
a functional B-cell receptor by using EBV-
encoded proteins. EBV infection and
expression of latent EBV-associated
proteins (LMP1) is also associated with
activation of NF-κB as well as JAK/STAT
pathways.
12. A possible model of pathogenesis
germinal
centre
B cell
transforming
event(s)
loss of apoptosis
RS cell
inflammatory
response
EBV?
cytokines
12
13. Risk Factors
• No clear risk factors, several implicated
• EBV (pathogen or passenger)
• HIV
• woodworking, farming
• rare familial aggregations
• First degree relatives have five fold increase in risk for
Hodgkin lymphoma.
• Associated with EBV infection mainly with mixed cellularity
type.
• High socio economic status.
• Prolonged use of of human growth hormone.
• men > women
• whites > blacks > Asians
13
14. HISTOLOGICAL FEATURES
• An accurate histological diagnosis of cHL is
made by recognizing the morphological and
immuno phenotypic characteristics of the HRS
cell within the appropriate cellular background.
• Systematic immuno histochemical evaluation
of both the tumour cell compartment (HRS
cells and its variants) and the associated
cellular background is important
15. Reed Sternberg cell
Common feature of ALL Hodgkin Lymphomas.
• Large cells ( 20-50 um in diameter) with classically binucleate
or bilobed central nucleus each with a large acidophilic central
nucleoli (mirror image) surrounded by a clear halo. “owl’s eye
appearance”
• Variants: mononuclear (Hodgkin’s cell), lacunar cell, L/H cell.
• Requirement of Reed-Sternberg cell for initial diagnosis is
“absolute”(less strict for LPHL or recurrent disease)
• Classic Reed-Sternberg cell:
+ CD15, CD30, CD25
– CD45, pan-B, S-100, keratin, EMA
High level of circulating tumor DNA detected in most cases and
suggestive of higher proliferatiom rate of tumor cells
15
17. Cytokines (such as IL-5, IL-10, IL-13, and
TGF-β) and chemokines (such as TARC, MDC,
IP-10, and CCL28) are secreted by Reed-
Sternberg cells.
They lead to florid accumulation of reactive
cells in tissues involved by classical HL.
These reactive cells produce factors that
support the growth and survival of the
tumor cells and further modify the reactive
cell response.
17
19. Lymph node, nodular-sclerosing Hodgkin lymphoma. (A) Clusters of Reed-Sternberg
cells and variants react with anti-CD15. (B) Reed-Sternberg cells in the same case show
negative results for CD45 (leukocyte common antigen), in contrast to positive
surrounding small lymphocytes.
A
B
19
21. Nodular Lymphocyte predominant
Hodgkin lymphoma(NLPHL)
• <5% of Hodgkin lymphoma
• Mainly involves cervical, axillary or mediastinal
• L&H cells or Popcorn cells are seen
• Positive for CD20, 45, CD79a, Bcl-6, J-chain, and PAX-5. EMA positive
in 50% cases.
• Negative for CD15, 30.
• Differential Diagnosis: Well differentiated lymphocytic lymphoma,
mononucleosis, malignant melanoma,, progressive transformation of
germinal centers
21
22. 22
•Small lymphocytes predominate in the reactive component in
both types and are intermixed with varying numbers of
histiocytes. Eosinophils, neutrophils, and “diagnostic” or
“classic” RS cells are rare. In fact, the diagnosis of NLPHL is
doubtful if diagnostic RS cells are found easily; the number of
such cells should be fewer than one per histologic section.
•In NLPHL, RS cells are conspicuous with folded, multilobed
nucleus and smaller nucleoli(“popcorn nuclei”).
•In the nodular subtype of LPHL, there is almost total
obliteration of the nodal architecture by a vaguely nodular
process.
•LPHL nodules are composed of small, round lymphocytes with
varying numbers of epithelioid histiocytes which gives them a
mottled appearance. L&H variants of RS cells may be
numerous and are principally seen in the nodules.
24. • An attenuated rim of residual normal node (top) is often present in
nodular NLPHL. The vaguely nodular growth pattern and compressed
adjacent normal node seen at low magnification are features highly
suggestive of Nodular NLPHL.
24
26. 1. Nodular Sclerosis
• Most common type diagnosed
• About 70%
• Lacunar cells seen
• CD15, 30 positive
• EBV negative
• Only subtype without a male predominance
• Seen in younger patients with stage I-II disease.
• Differential diagnosis: Large cell Non Hodgkin lymphoma, carcinoma,
germ cell tumour and thymoma.
26
27. The classic histopathologic criteria for NSHL are
(a) prominent nodularity
(b) presence of lacunar RS cell variants, and
(c) birefringent broad collagen bands
• Nodal architecture is obliterated by relatively large nodules of tumor
partly or totally encircled by dense connective tissue bands that are
birefringent when viewed under polarized light.
27
28. LACUNAR VARIANT RS CELL : These variants possess large, multilobated, or
irregular nuclei with finely dispersed chromatin; nucleoli are usually small.
The cytoplasm of lacunar cells retracts when fixed in formalin, so the
nuclei gives the appearance of cells that lie with empty spaces between
them. (lacunae)
28
29. • Hodgkin lymphoma, nodular sclerosis type. A low-power view shows well-
defined bands of pink, acellular collagen that subdivide the tumor into
nodules 29
30. 2. Mixed Cellularity
• Constitutes about 20%
• More than 50% present as stage III or IV disease
• Biphasic incidence, peaking in young adults and again in adults
older than 55
• CD15, 30, EBV positive
• Presents in advanced stages
• Tendency to involve spleen, bone marrow.
• Differential diagnosis: Some cases of MCHL display an interfollicular
growth pattern. Such cases may be difficult to distinguish from peripheral
T-cell lymphomas. Lennert’s lymphoma (diffuse mixed T-cell ML with
excessive histiocytes). Diffuse follicular lymphoma.
30
31. Lymph node, mixed-cellularity Hodgkin lymphoma disease. Diagnostic Reed-
Sternberg cells are usually found without difficulty in mixed-cellularity
Hodgkin lymphoma. The reactive component consists of small, round
lymphocytes, histiocytes, plasma cells, and eosinophils,
31
32. 3. Lymphocyte Depleted
• Constitutes <1%
• Worst prognosis of all subtypes
• Older males, rare in children
• Present as febrile illness with
pancytopenia, hepatomegaly, and no
peripheral lymphadenopathy
• Advanced stage, Stage IV
• The biologic hallmark of LDHL is a
collapse of cell-mediated immunity,
HIV infection
• RS cells CD15+, CD30+; most EBV+
• Differential Diagnosis: Large cell Non-
Hodgkin’s lymphoma. Nodular
sclerosis HL
32
33. 4. Lymphocyte-Rich
• RS cells CD15+, CD30+; 40% EBV+
• App 5% of cases
• M > F
• Tends to be seen in older adults
• This is an uncommon form of classical HL
• Reactive lymphocytes make up the vast majority of the cellular infiltrate.
In most cases, involved lymph nodes are diffusely effaced, but vague
nodularity due to the presence of residual B-cell follicles is sometimes
seen.
• Differential Diagnosis: This entity is distinguished from the lymphocyte
predominance type by the presence of frequent mononuclear variants and
diagnostic Reed-Sternberg cells with a “classical” immuno phenotypic
profile.
• Very good to excellent prognosis.
33
36. CLINICAL FEATURES
• Hodgkin lymphoma arises in a single node or chain of nodes
and spreads first to anatomically contiguous lymphoid tissue.
• Visceral involvement by hodgkin lymphoma may be secondary
to extension from adjacent lymph nodes.
• Hematogenous spread occurs to liver or multiple bony sites.
• Mechanism of spleen involvement is unclear but all patients
with hepatic and bone involvement are associated with
splenic involvement.
36
37. • Most common presentation is asymptomatic lymph node
enlargement, typically in the neck.
• Cervical lymph nodes are involved in 80% cases.
• Mediastinal involvement is seen in about 50% cases. They
produce symptoms like chest pain, cough and dyspnoea.
• Infra diaphrgamatic involvement is seen in 5% cases and
usually seen with older patients.
• Other less common symptoms are :
Pruritis, alcohol induced pain over involved lymphnodes,
nephrotic syndrome, erythema nodosum, cerebellar
degeneration, immune hemolytic anaemia,
thrombocytopenia, hypercalcemia.
37
38. B symptoms
• About 33 % present with B symptoms overall
• Only 15-20% of stage I-III have B symptoms like
1. Fever(>38^C)
• May first present as fever of unknown origin
• Fever persists for days to weeks followed by afebrile intervals and then
recurrence.
• This pattern is called Pel Ebstein fever.
2. recurrent Drenching night sweats
3. Weight loss (>10% in 6 months)
38
42. Peripheral Blood
• The peripheral blood shows non -specific abnormalities.
• There may be anaemia, either normocytic normochromic or less often,
hypochromic microcytic.
• Rouleaux formation is often increased as is the erythrocyte sedimentation
rate.
• Some patients have neutrophilia, eosinophilia or thrombocytosis
• Occasional patients have lymphocytosis.
• Lymphopenia is common, with severe lymphopenia being seen in patients
with advanced disease or with unfavourable histological categories.
43. • Anaemia, leucopenia and pancytopenia are common in patients
with bone marrow infiltration
• The neoplastic cells of classical Hodgkin lymphoma rarely if ever
circulate in the peripheral blood; occasional instances of this
phenomenon have been reported but not in recent decades and
the diagnosis of the cases reported might therefore be doubted.
• In multivariate analysis an increased WBC and a reduced
lymphocyte count are of prognostic significance
45. • The demonstration of
infiltration requires
trephine biopsy
• Detection rate is higher
with bilateral biopsy or
single large biopsy
• Diagnostic cells are
rarely present in films
of aspirate.
• BM infiltration is more
likely with B symptoms,
stage 3 & 4,anemai.
46. Bone marrow trephine biopsy from a patient with
stage IV classical Hodgkin lymphoma demonstrates
diagnostic Reed-Sternberg and Hodgkin cells
48. Spread
• Generally a well behaved spread of disease through contiguous LN
groups, (especially NS and LP); <5% show non-contiguous spread
• May have direct extension into perinodal tissue.
• 85% of Stage I/II disease are above diaphragm.
• Spleen: if >400g, almost always positive.
• Liver: if positive, spleen and retroperitoneal LN’s are also positive.
48
49. Ann Arbor Staging System
• Stage I: Single lymph node region (I) or single extralymphatic organ or
site (IE)
• Stage II: > 2 lymph node regions on same side of diaphragm (II) or with
limited, contiguous extra lymphatic tissue involvement (IIE)
• Stage III: both sides of diaphragm involved, may include spleen (IIIS) or
local tissue involvement (IIIE)
• Stage IV: multiple/disseminated foci involved with > 1 extra lymphatic
organs (i.e. bone marrow)
(A) or (B) designates absence/presence of “B” symptoms
*(E) Localized, solitary involvement of extra lymphatic tissue, excluding
liver and bone marrow 49
50. Stage I Stage II Stage III Stage IV
Staging of lymphoma
A: absence of B symptoms
B: fever, night sweats, weight loss
50
53. 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 radio therapy)
• Involved field radiotherapy is the most commonly used technique at
present. It targets a smaller area rather than a classical extended field.
53
54. Novel agents
• One of the single most effective new anti-HL therapies emerge is
brentuximab vedotin (BV)
• BV is an antibody–drug conjugate, which consists of an anti-CD30
antibody conjugated to an antimicrotubule agent (monomethyl auristatin
E (MMAE)). .
• Other agents that have shown promise in cHL include the
immunomodulatory drug lenalidomide, the histone deacetylase inhibitors
(e.g. panobinostat) and the anti-PD-1 antibody nivolumab.
55. LATE EFFECTS/COMPLICATIONS
• Due to the high cure rates achieved by the treatment of both early stage and advanced stage
cHL, patients treated for cHL are at risk of numerous late toxicities related to treatment.
• During the first 10 years after diagnosis, most deaths are the result of relapse, however, after
this period most deaths are a result of late effects of treatment.
• For early-stage disease, the cause of death for the majority of patients overall is related to
treatment rather than cHL.
• The chronic toxicity profile of cHL treatment depends on numerous factors, including the
intensity of chemotherapy regimen, types of chemotherapeutic agents to which the patient is
exposed, site of radiotherapy fields and age of patient at treatment.
56. Secondary solid organ malignancy
• Patients treated for HL have an approximately 3 fold increased risk of solid organ malignancy
• The most common secondary malignancies are ;
breast
lung
gastrointestinal tract cancers
• Radiotherapy increases the risk of secondary solid organ malignancy at exposed sites, whereas
chemotherapy has a more complex association with secondary solid organ malignancy, resulting in an
increased risk of some types (e.g. colorectal carcinoma associated with procarbazine use), but also acting
to abrogate the risk of others (e.g. reduction of breast cancer risk in patients receiving radiotherapy
through reducing ovarian function and inducing premature menopause).
• One of the most potent determinants of the risk of developing a secondary solid organ malignancy is the
age at which the patient received treatment
57. Secondary myeloid malignancy
• The risk of secondary MDS/AML is approximately 1% or less with ABVD,
but may be up to 4% with escalated BEACOPP.
Cardiovascular disease
• Patients treated for cHL are at an increased risk of late cardiovascular
disease. This is contributed to by exposure of the heart to radiotherapy, as
well as treatment with anthracycline based chemotherapy regimens. The
latency of coronary artery disease as a result of radiotherapy is
approximately 10 years. Importantly, concomitant cardiovascular risk
factors including hypertension, hypercholesterolemia and smoking all
compound this risk and should be aggressively managed.
58. Infertility
• Women (regardless of age) receiving escalated BEACOPP have severely reduced
ovarian reserve and significantly higher rates of sustained amenorrhea post
treatment.
• Women over the age of 30 treated with BEACOPP regimens have a 50% rate of
sustained amenorrhea (4 years) post treatment and those over 35 treated with
escalated BEACOPP have a less than 5% rate of return to a regular menstrual cycle.
• For male patients,sperm storage can usually be offered before treatment.
60. History
• • Female patient, 12years old, presented on 10/2009 .
• • The condition started 2 weeks ago with sever diffuse abdominal pain, abdominal distention ,
absolute constipation so patient sought medical advice and was diagnosed as acute intestinal
obstruction.
• Urgent exploration done with intestinal mass found and completely excised moderate to high grade
fever mainly by night, partially responding to medical treatment.
• • The condition was associated with small right neck swelling of lemon size surgical removal of
which showed a non malignant nature.
• On 5/2010, patient developed multiple painless neck swellings with gradual onset progressive
course associated with night fever and weight loss - no drenching night sweating.
• • Surgical removal of cervical swelling was done and patient was referred to us.
• • No manifestation of other system affection was apparent.
61. Examination & Workup
Lymphatic system:
• Right upper deep cervical LN about 3*2 cm
• Multiple small left upper deep cervical LNs the largest one about 1 cm in diameter
• RT axillary LN about 1,5 cm in diameter in the apical group
• All of the above described lymph nodes are firm to rubbery in consistency, non
tender, freely mobile and with normal overlying skin
• No other enlarged LN groups
Laboratory workup:
ESR: 1st hr 25
Imaging Workup:
CT neck : Multiple bilateral upper and lower deep cervical LNs the largest one on RT
side about 3*2.5 cm, the largest one on the left side about 1 *1 cm
US axillae: Multiple bilateral axillary LNs the largest one on the RT side about 1.6*0.8
cm most of them show loss of the central hilum mostly pathological LNs
Echo: FS 36 with MR grade1
Pulmonary Function Test : Free
Pathology report
Suggestive of Hodgkin lymphoma, nodular lymphocytic predominant type with tumor
cells positive for CD20
Bone marrow biopsy Free
62. Management
Final Diagnosis :
Hodgkin lymphoma, nodular lymphocytic predominant type stage 2B, non bulky disease
Treatment plan:
4 courses of ABVD /COEP then IFRTH 25 gy/17 settings on neck and axillae
Evaluation after 2 courses:
CT neck : multiple enlarged cervical LNs the largest one about 1cm
Axillae US: RT LN with eccenteric hilum largest 1cm
Evaluation after another 2 courses and IFRTH:
CT neck : multiple enlarged cervical LNs the largest one about 1cm.
Axillae US: RT LN with eccenteric hilum largest one about 1 cm.
Other imaging investigations, Echo, PFT, BMB were free
63. Prospective Approach
• What is the current situation?
• - Patient finished treatment on 11-2010 -
Patient is in CR up till now and on follow up
for 2,5 years now
• What is the future plan ?
• - Patient is under regular follow up in our
outpatient clinic