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Key Points

  1. Staging laparotomy is no longer necessary for work-up of lymphomas.

  2. Hodgkins Disease accounts for 6% of pediatric malignancies and is the most commonly diagnosed cancer among adolescents aged 15 to 19.

  3. The initial step to diagnosis of the Hodgkin lymphoma is lymph node biopsy. If a surgeon decides to approach a mediastinal mass thorascopically, they must ensure that adequate specimens are obtained as up to 50% of mediastinal cases required a second diagnostic biopsy when a thoracoscopic biopsy was performed.

  4. Non-Hodgkin Lymphomas (NHL) are a varied group of tumors with almost 60 unique subtypes, accounting for 7% of tumors and are typically high grade.

  5. For the Burkitt lymphoma, the prognosis is dependent on the extent of disease rather than on completeness of surgical resection.

The treatment for a child with Lymphoma requires a multidisciplinary team of healthcare professionals. Outcomes have improved and current multimodality therapy is focused on reducing the toxicity of treatment. The main role of surgery is for diagnosis. However, there are several key issues that a surgeon must be cognizant of when treating a child with a presumptive lymphoma. For example, extreme caution must be used in a child with respiratory compromise due to a large mediastinal mass suspected to be a lymphoma, alternatively, emergency surgery may be necessary in a child with a gastrointestinal lymphoma.

The Hodgkin Lymphoma

The Hodgkin lymphoma is named after Thomas Hodgkin a British pathologist who in 1832 described the disease in a paper titled, “On Some Morbid Appearances of the Absorbent Glands and Spleen.” It was not until years later that Sternberg (1898) and Reed (1902) described the distinctive multinucleated giant cell with prominent nucleoli that are characteristic of HD (Fig. 95-1). Reed–Sternberg cells are derived from germinal center B cells and are the pathognomonic cells of HL. Cure rates for pediatric HL are excellent approaching 90% to 95% (Fig. 95-2).

Figure 95-1

High-power hematoxylin and eosin stained slide of a patient with Hodgkin Lymphoma and typical Reed Sternberg cells.

Figure 95-2

Graph shows survival statistics of different pediatric cancers from 1975 to 2003.

Incidence and Epidemiology

HL accounts for 6% of all pediatric malignancies, with an incidence of about 6 cases per 1 million. HL has a bimodal distribution with peaks in adolescence (15-19 yrs) and after age 55 years. Epidemiologic studies identify 3 forms of HL; Childhood HL, Adolescent Young Adults (AYA) and Older Adult HL. Childhood HL is found in children less than 14 years and accounts for 10-12% of cases. It is more common in males and the histological subtype is more likely to be mixed cellularity or nodular lymphocyte predominant. Risk factors for childhood HL include increasing ...

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