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Hodgkin's Lymphoma

Hodgkin's Lymphoma


This is progressive, painless enlargement of lymphoid tissues throughout the body.
EB virus involvement is thought to be one of the aetiologies.

Pathological classification

  1. Lymphocyte predominant
  2. Nodular sclerosis
  3. Mixed cellularity
  4. Lymphocyte depleted
Characteristically, cells with mirror image nuclei (REED-STERNBERG CELLS) are seen.


Clinical features

Patient present with enlarged, painless lymph nodes, alcohol induced pain pain over the enlarged nodes, and features due to the mass effect of the node.
25% have constitutional symptoms like fever, weight loss, night sweats and pruritus.
Hepatosplenomegaly may also be present.

Investigations

  1. Lymph node biopsy 
  2. Bone marrow biopsy
  3. Liver biopsy
  4. Lymphopenia indicates bad prognosis.
  5. Moderate eosinophilia may occur in 10 to 15% of the patients.

Clinical staging (Ann-Arbor Classification)

Stage 1

Involvement of a single lymph node region (1) or extra-lymphatic site (E)

Stage 2


Involvement of two or more lymph node regions (2) or an extra-lymphatic site and lymph node regions on the same side of the diaphragm (2E)

Stage 3

Involvement of lymph node regions on the both sides of diaphragm with (3E) or without (3) localised extra-lymphatic involvement involvement or involvement of the spleen (3S) or both (3SE)

Stage 4

Diffuse involvement of one or more extra lymphatic tissues, e.g. liver or bone marrow. The lymphatic structures are lymph nodes, spleen, thymus, waldeyer's ring, appendix and payer's patches.

Management

Radiotherapy

It is indicated for stage 1A and 2A.
Irradiation b/w 3600 and 4400 cGy is given to contaguous regions of lymphoid tissue.

Radiation fields

MANTLE FIELD - All major sites of lymphoid tissue above the diaphragm.
SPADE FIELD - The periaortic and spleen nodes or spleen.
INVERTED Y FIELD - Periaortic and splenic field including the iliac, hypogastric and inguinal nodes.

Chemotherapy

Indications
  1. All patients with B symptoms
  2. Stage 2 disease with more than 3 areas of involvement
  3. Stage 3 and stage 4 disease.
Chemotherapy is usually given with MOPP and MVPP regimes which employ mustine hydrochloride as the alkylating agents.

MOPP - Mustine, oncovin (vincristine), procarbazine, prednisolone

MVPP - Mustine, vinblastine, procarbazine, prednisolone

ChlVP - Chlorambucil, vinblastine, procarbazine, prednisolone

All regimens cause myelotoxicity and there is a small risk of developement of acute leukaemia.

ABVD - Adriamycin, bleomycin, vinblastin, dacarbazine regimen do not carry the risk of development of acute leukaemia.



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