Hodgkin's lymphoma is characterized by the presence of Reed-Sternberg cells. It is classified into five subtypes based on cell morphology. Hodgkin's lymphoma most often presents as painless enlargement of single or adjacent lymph nodes and commonly spreads in an orderly fashion. Investigations include CBC, ESR, LDH, imaging and bone marrow biopsy. Treatment involves chemotherapy such as ABVD or MOPP regimens depending on disease stage and prognosis. Late effects of treatment can include leukemia, second malignancies, and organ damage.

1. HODGKIN’S
LYMPHOMA
DR. SIDDHARTH

2. INTRODUCTION
 Characterized by the presence of tumor giant
cell
“ Reed-Sternberg cell”.
 It is classified into five subtypes:
1. Nodular Sclerosis
2. Mixed Cellularity
3. Lymphocyte Rich
4. Lymphocyte Depleted
5. Lymphocyte Predominance

3. “Reed-Sternberg cell”

4. DIFFERENCE
HODGKIN’ LYMPHOMA NON HODGKIN’S
LYMPHOMA
MORE OFTEN LOCALISED IN
SINGLE AXIAL GROUP OF
LYMPHNODES
MORE FREQUENT INVOLVEMENT
OF PERIPHERAL NODES
ORDERLY SPREAD BY
CONTIGUITY
NON CONTIGUOUS SPREAD
MESENTRIC LYMPHNODES AND
WALDAYER RING RARELY
INVOLVED
COMMONLY INVOLVED
EXTRA NODAL INVOLVEMENT
UNCOMMON
EXTRA NODAL INVOLVEMENT
COMMON

5. SPREAD

6. CLINICAL FEATURES
 PAINLESS ENLARGEMENT OF
LYMPHNODES IS THE COMMON
PRESENTING SYMPTOM.
 Can be associated with fever (Pel Ebstein
Fever) and night sweats in disseminated
disease.
 Wt loss > 10 % of body wt.
 A strange paraneoplastic syndrome in HL is
pain in the affected lymphnodes on
consumption of alcohol.

7. UNUSUAL MANIFESTATIONS
 Severe and unexplained itching
 Cutaneous disorders such as erythema
nodosum and icthyosis form atrophy.
 Nephrotic syndrome
 Immune hemolytic anemia and
thrombocytopenia
 Hypercalcemia
 Paraneoplastic cerebellar degeneration

8. NODULAR
SCLEROSIS
MIXED
CELLULARITY
LYMPHOCYTE
RICH
LYMPHOCYE
DEPLETED
LYMPHOCYTE
PREDOMINAN
T
MC TYPE OF
HL
MC TYPE IN
INDIA
ASSOCIATED
WITH HIV
INCIDENCE
EQUAL IN M &
F
M>F M>F M>F M>F
RS CELL
VARIANT IS
LACUNAR
CELL
MAXIMUM NO
OF RS CELLS
MONO
NUCLEAR RS
CELLS
MUMMIFIED,
NECROBIOTIC
POPCORN
CELLS
CD 15+, CD
30+
CD 15+, CD
30+
CD 15+, CD
30+
CD 15+, CD
30+
CD 20 +, BCL
6+ & EMA +
NOT
ASSOCIAT
WITH EBV
ASSOCIATED WITH EBV NOT
ASSOCIAT
WITH EBV
EXCELLENT
PROGNOSIS
PROGNOSIS
VERY GOOD
GOOD POOR
PROGNOSIS
EXCELLENT
PROGNOSIS

9. MORPHOLOGY

10. INVESTIGATIONS
 CBC- ANEMIA, EOSINOPHILIA,
NEUTROPHILIA
 ESR- RAISED
 LDH
 LFT AND RFT PRIOR TO RX
 CHEST RADIOGRAPH – MEDIASTINAL
MASS
 CT SCAN OF CHEST,ABDOMEN,PELVIS
FOR STAGING
 BONE MARROW BIOPSY

11. Ann Arbor staging

12. TREATMENT
 Patients with localised disease are cured 90%
of time.
 In patients with good prognostic factors,
extended field radiotherapy has a high cure
rate.
 Patients with more extensive disease or those
with B symptoms receive a complete course of
chemotherapy.

13. Cont….
 Chemotherapy regimens used in hodgkins
disease
ABVD REGIMEN MOPP REGIMEN
A- ADRIYAMYCIN M- MECHLORETHAMINE
B- BLEOMYCIN O- VINCRISTINE
V- VINBLASTINE P- PROCARBAZINE
D- DACARBAZINE
P- PREDNISONE

14.  Today in US most patients receive ABVD but a
weekly chemotherapy regimen administered
for 12 weeks called stanford V is becoming
increasingly popular.
 Patients who relapse after primary
chemotherapy can frequently still be cured.

15.  The most serious late side effects include:
1. Acute leukemias
2. Second malignancies- Lung, Breast
3. Coronary artery disease
4. Hypothyroidism
5. Lhermittes’s syndrome
6. Infertility

16. DD OF A LN BIOPSY
SUSPICIOUS FER HODGKIN’S
DISEASE
 INFECTIOUS MONONUCLEOSIS
 NON HODGKINS LYMPHOMA
 PHENYTOIN INDUCED ADENOPATHY
 NON LYMPHOMATOUS MALIGNANCIES

17. THANK YOU