Hodgkin Lymphoma

• • A malignant neoplasm that originates in lymphoid tissue

  • Characterized histologically by the presence of Reed-Sternberg cells

  • Develops in lymph nodes and spreads in an orderly fashion to contiguous lymph node beds

  • Several histologic subtypes exist based on lymphocyte infiltration:

  • -Nodular sclerosis: 70%

    -Mixed cellularity: 20%

    -Lymphocyte predominance: 6%

    -Lymphocyte depletion: 2%

  • Most important prognostic factor is the disease stage

  • -Ann Arbor staging system most accepted classification

Epidemiology

• • Bimodal age distribution with first peak occurring in the 20s and the second peak over age 50

  • Incidence appears to be higher among patients who meet the following criteria:

  • -Fewer siblings

    -Early birth order

    -Siblings with Hodgkin disease

    -Fewer playmates

    -Certain HLA antigens

    -Single-family dwellings

    -Post tonsillectomy

    -Immunodeficiency

Symptoms and Signs

• • Nontender enlargement of lymph nodes

  • Constitutional symptoms that lead to a "B" designation include:

  • -Fever

    -Drenching night sweats

    -Weight loss

Laboratory Findings

• • No distinctive basic laboratory findings present, although lymphomas tend to be associated with an elevated lactate dehydrogenase level

Imaging Findings

• • Imaging findings are specific to the location and stage

  • Chest film: May demonstrate mediastinal adenopathy

  • CT scan is the main staging tool used to demonstrate contiguous areas of adenopathy

• • Hodgkin lymphoma

  • Non-Hodgkin lymphoma

  • Reactive lymphadenopathy

  • -Infectious mononucleosis

    -Cat-scratch disease

    -HIV

    -Drug reactions (eg, phenytoin)

  • Tumor metastases

Rule Out

• • Reactive lymphadenopathy

  • Metastatic disease to the lymph nodes

• • Detailed history; ask about risk factors and presence of constitutional B-symptoms

  • Thorough physical exam assessing all lymph node beds

  • Routine laboratory testing

  • Excisional biopsy of enlarged lymph node

  • Bone marrow biopsy

  • CT scans of the neck, chest, abdomen, and pelvis

When to Admit

• • Most patients with lymphadenopathy suspicious for lymphoma are evaluated urgently as an outpatient or admitted to expedite the process

When to Refer

• • Following histologic diagnosis, patients are referred to medical and radiation oncologists for definitive treatment

• • Treatment of Hodgkin disease involves radiation for localized disease and a combination of radiation and chemotherapy for more advanced disease

Surgery

• • Excisional lymph node biopsy to establish diagnosis

  • Rarely, a staging laparotomy is necessary if the anatomic extent of disease in the abdomen is important in guiding therapy

Medications

• • The 2 common chemotherapy regimens include:

  • -MOPP (mechlorethamine, oncovorin, procarbazine, and prednisone)

    -ABVD (adriamycin, bleomycin, vinblastine, and dacarbazine)

Treatment Monitoring

• • Physical exam to evaluate for lymphadenopathy

  • Radiographic evaluation as clinically indicated (eg, with the re-development of constitutional "B" symptoms)

Complications