This document discusses the different subtypes of Hodgkin's lymphoma. It notes that Hodgkin's lymphoma is typically localized with orderly spread through contiguous lymph nodes, while non-Hodgkin's lymphoma can spread non-contiguously. The main subtypes discussed are nodular sclerosis, mixed cellularity, lymphocyte depletion, and lymphocyte rich, along with their characteristics such as associated Epstein-Barr virus presence, patient demographics, histological features, and prognosis.
3. 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
4.
5. 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.
6. Unknown
EBV plays a role 50% present in
R-S cells (Mixed Cellularity)
High incidence Hx of IM
Genetic Susceptibility
7. 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
8. 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
10. 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
11. 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
12. 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
13. 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
14. 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
15.
16. MOST COMMON 65-70%
MALE = FEMALES
ADOLESCENT & YOUNG
ADULTS
EXCELLENT PROGNOSIS
27. 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
28. 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
30. <5 % LEAST COMMON
OFTEN ASSOC. EBV
COMMON
* OLDER PTS.
* HIV
* NON-INDUSTRIALIZED COUNTRIES
SYSTEMIC SYMPTOMS
PRESENT AS ADVANCED STAGE
PROGNOSIS LESS FAVORABLE