Collection of lymphoid malignancies in whichmalignant lymphocytes accumulate in lymphnodes and lymphoid tissues, leading t...
Malignant proliferation of lymphoid cells with  Reed-Sternberg cells (thought to arise from  germinal center B-cells) Bim...
 Classic:    Nodular Sclerosis    Lymphocyte rich    Mixed Cellularity    Lymphocyte depleted Non-Classic:  Nodular...
   Stage I                 involvement of a single lymph node region or extra    lymphatic organ or site   Stage II     ...
subtypes:A = absence of B symptomsB = presence of B symptoms
 Asymptomatic lymphadenopathy (70%)   most often cervical region   asymmetrical, discrete   painless, non-tender   el...
 Splenomegaly (50%) ± Hepatomegaly Mediastinal mass found on routine CXR, may be  symptomatic (cough) rarely may present...
   Fever sometimes cyclical (‘Pel-Ebstein fever’)   Alcohol induced pain in nodes   Neprotic syndrome   Pallor   Prur...
   Inflammatory processes   Mononucleosis   Non-hodgkin’s lymphoma   Phenytoin-induced adenopathy   Non lymphomatous ...
Chronic hodgkin’s lymphoma in a 11year old
   CBC:         Anemia ( normochromic / normocytic),    eosinophilia, neutrophilia, lymphopenia, platelets    normal or i...
   LN FNAC / biopsy :     Malignant REED-STERNBERG ( RS) Cell: Bi-nucleate cell      with a prominent nucleolus. Derived...
a large cell with a bilobed nucleus and prominentnulceoli giving owl’s   eye appearance
    Cardiac Function Assessment - ( Echo for EF)                                        for pts at high     risk of pre-t...
Nodular sclerosis type
Spleen in hodgkin’s
Stage 1 in hl
>10 cmBulky disease
Lymphangiography
   Stage IA , Stage IIA with 3 or < 3 areas involved:    Radiotherapy   Stage IB, Stage II A with > 3 areas , Stage IIB:...
Irradiation fields used in Hodgkin’s Lymphoma
   Cardiac disease - 2° to XRT, adriamycin is cardio toxic   Pulmonary disease - secondary to bleomycin ( interstitial  ...
1. Serum Albumin <4 gm/dL2. Hemoglobin <10.5 gm/ dL3. Male4. Stage IV disease5. Age:<45 years6. Leukocytosis (WBC >15000 c...
Hodgkin's lymphoma
Hodgkin's lymphoma
Hodgkin's lymphoma
Hodgkin's lymphoma
Hodgkin's lymphoma
Hodgkin's lymphoma
Hodgkin's lymphoma
Hodgkin's lymphoma
Hodgkin's lymphoma
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Hodgkin's lymphoma

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Hodgkin's lymphoma

  1. 1. Collection of lymphoid malignancies in whichmalignant lymphocytes accumulate in lymphnodes and lymphoid tissues, leading tolymphadenopathy, extra nodal disease andconstitutional symptoms.
  2. 2. Malignant proliferation of lymphoid cells with Reed-Sternberg cells (thought to arise from germinal center B-cells) Bimodal distribution with peaks at the age of 20-30 years and >50 years Association with Epstein-Barr virus in up to 50% of cases M>F
  3. 3.  Classic:  Nodular Sclerosis  Lymphocyte rich  Mixed Cellularity  Lymphocyte depleted Non-Classic:  Nodular Lymphocyte predominant*REAL – Revised European American lymphoma
  4. 4.  Stage I involvement of a single lymph node region or extra lymphatic organ or site Stage II involvement of two or more lymph node regions or (IIe) an extra lymphatic site and one or more lymph node regions on same side of diaphragm Stage III involvement of lymph node regions on both sides of the diaphragm; may (IIIe) or may not (III) be accompanied by single extra lymphatic site or (IIS) splenic involvement or both (IISe) Stage IV diffuse involvement of one or more extra lymphatic organs (BM and liver)
  5. 5. subtypes:A = absence of B symptomsB = presence of B symptoms
  6. 6.  Asymptomatic lymphadenopathy (70%)  most often cervical region  asymmetrical, discrete  painless, non-tender  elastic character on palpation ( rubbery)  not adherent to skin  fluctuate in size Cervical/ Supra clavicular (60-80%), Axillary (10- 20%),Inguinal (6-12%)Contiguous spread via the lymphatic chain eg. involvement of abdominal & thoracic LNs
  7. 7.  Splenomegaly (50%) ± Hepatomegaly Mediastinal mass found on routine CXR, may be symptomatic (cough) rarely may present with SVC syndrome, pleural effusion Constitutional symptoms ( B symptoms )  Night sweats,  sustained fever > 38 degree Celsius (in 30% pts.),  loss of weight >10% of body weight in 6 months
  8. 8.  Fever sometimes cyclical (‘Pel-Ebstein fever’) Alcohol induced pain in nodes Neprotic syndrome Pallor Pruritis Symptoms of Bulky (>10 cm) disease
  9. 9.  Inflammatory processes Mononucleosis Non-hodgkin’s lymphoma Phenytoin-induced adenopathy Non lymphomatous malignancies
  10. 10. Chronic hodgkin’s lymphoma in a 11year old
  11. 11.  CBC: Anemia ( normochromic / normocytic), eosinophilia, neutrophilia, lymphopenia, platelets normal or increased early, decreased in advanced disease ESR –raised(monitor disease progression) LFT- (liver infil / obs at porta hepatis) RFT- prior to treatment ALP, Ca (Bone involvement) LDH - adverse prognosis CXR- mediastinal mass CT thorax / abdomen / pelvis-for staging Other: Gallium scan (asses t/t response), PET, Bipedal Lymphangiography , Laporotomy (for staging)
  12. 12.  LN FNAC / biopsy :  Malignant REED-STERNBERG ( RS) Cell: Bi-nucleate cell with a prominent nucleolus. Derived from B cell, at an early stage of differentiation  Reactive background of eosinophils, lymphocytes, plasma cells  Fibrous tissuebone marrow biopsy to assess marrow infiltration (only necessary if B symptoms, stage III or IV, bulky disease or cytopenia)
  13. 13. a large cell with a bilobed nucleus and prominentnulceoli giving owl’s eye appearance
  14. 14.  Cardiac Function Assessment - ( Echo for EF) for pts at high risk of pre-treatment cardiac disease (age :>60, history of HT, CHF, CAD, MI, CVA) PFTs - if history of lung disease (COPD, Smoking, Previous radiation to lung)
  15. 15. Nodular sclerosis type
  16. 16. Spleen in hodgkin’s
  17. 17. Stage 1 in hl
  18. 18. >10 cmBulky disease
  19. 19. Lymphangiography
  20. 20.  Stage IA , Stage IIA with 3 or < 3 areas involved: Radiotherapy Stage IB, Stage II A with > 3 areas , Stage IIB: Chemotherapy (every 3-4 weeks, 6-8 cycles; either alone, or in combination with radiotherapy) =>ABVD Stage III & IV : Chemotherapy (ABVD, BEACOPP) + Radiotherapy ( for bulky disease or palliation of symptoms) Relapse, resistant to therapy: high dose chemotherapy, bone marrow transplantBEACOPP( bleomycin, etoposide, adriamycin, cyclophosphamide, vincristine, procarbazine, prednisolone)ABVD(Adriamycin, Bleomycin, Vinblastin, Dacarbazine)
  21. 21. Irradiation fields used in Hodgkin’s Lymphoma
  22. 22.  Cardiac disease - 2° to XRT, adriamycin is cardio toxic Pulmonary disease - secondary to bleomycin ( interstitial pneumonitis) Infertility - recommend sperm banking Secondary Malignancy in irradiated field 2% risk of MDS, AML (2° to treatment, usually within 8 years) • solid tumors of lung, breast, >10 years after treatment • non-Hodgkins lymphoma Hypothyroidism - post XRT Infection - post splenectomy (give Pneumovax, HiB, and pneumococcal conjugate vaccines), during treatment
  23. 23. 1. Serum Albumin <4 gm/dL2. Hemoglobin <10.5 gm/ dL3. Male4. Stage IV disease5. Age:<45 years6. Leukocytosis (WBC >15000 cells/dL)7. Lymphocytopenia (lymphocytes <8% of WBC)

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