Hodgkins Lymphoma

lymphoma

most common blood cancer and 3rd most common cancer of childhood

lymphoma

occurs when lymphocytes grow abnormally

lymphoma

lesions derived from precursor immature and mature lymphoid cells, B-cells, T-cells neoplasms

1. age

2. weak immune system

3. family history

4. infections

5. radiation

causes and risk factors of lymphoma

older than the age of 60

majority of people diagnosed are

children

disease develops when they have a pre-existing immune deficiency

HIV/AIDS

other illnesses/diseases like _____ make the body more susceptible to lymphoma

• HIV/AIDS

• Epstein-Barr virus

• Hepatitis C

• Helicobacter pylori

infections that increases risk

Hodgkin Lymphoma

marked by the presence of the Reed-Sternberg cell, a large cell that increases in number as the disease advances

Reed-Sternberg cell

a large cell that increases in number as the disease advances

Hodgkin Lymphoma

is highly curable with a survival rate that is considered very high

lymph tissue; lungs, bone marrow, blood

Hodgkin lymphoma affect the ________ in the lymphatic system but can spread to the __________

Non-Hodgkin Lymphoma

are of several types, characterized as fast or slow-growing an as originating from T-cells or B-cells

Non-Hodgkin Lymphoma

prognosis and treatment, depend on the stage and type of disease

45 um

diameter or Reed-Sternberg Cell may be up to

acidophilic

Reed-Sternberg Cell has an abundant _____ cytoplasm

binucleated, multinucleated, or polylobated

nucleus of Reed-Sternberg Cell

gigantic

Reed-Sternberg cell is _____, more than 5um in diameter, with large inclusion-like nucleoli

halo effect

Reed-Sternberg cell often has a clearing of the chromatin around the macronucleoli, resulting in a distinct ____

Hodgkin lymphoma

is a cancer of lymph tissue found in the lymph nodes, spleen, liver, bone marrow, and other sites

Hodgkin Lymphoma

a distinct primary solid malignancy of the immune system in which the exuberant production of cytokines and chemokines is associated with the abundance of a component of inflammatory cells that outnumber the recognized subpopulation of Hodgkin and Reed-Sternberg (H/RS) cells, derived from the germinal center B cells

germinal center B cells

Hodgkin and Reed-Sternberg cells are derived from

Hodgkin Lymphoma

was the first of the lymphomas to be recognition

lymphatic system

lymph vessels-network that branch to all tissue of the body

lymph

clear fluid that contains WBCs, especially lymphocytes such as B & T cells

lymph nodes

small round masses of tissue found in neck, underarms, chest, abdomen, groin

tonsils, thymus, spleen

lymphatic system other parts

spleens

____ involved by Hodgkin’s lymphoma may show a single or few large nodules

Thomas Hodgkin (1832)

described what he believed to be a primary yet benign disease of the lymphoid tissue

Samuel Wilkes (1865)

suggested that the disorder described by Hodgkin was a malignant process and was the first to apply the term Hodgkin disease

Sternberg (1898) & Reed (1902)

described the distinctive histological features of the disease, including the peculiar cell (R/S) cell, which now bears the name

unknown

causes of Hodgkin Lymphoma

15-30, 50-70

HL is common among ages

1. past infections with the Epstein-Barr virus

2. patients with HIV

HL risk factors

swollen glands

one symptom of HL in which there is a painless swelling of the lymph nodes in the neck, armpit, or groin

1. blood chemistry tests: protein levels, liver function tests, kidney function tests, uric acid level

2. bone marrow biopsy

3. CT scans of the chest, abdomen, pelvis

4. CBC to check for anemia & WBC

procedures usually done to detect HL

Modified Ann Arbor

staging system for HD

Stage 1

single lymph node region involved with the disease

stage 2

two or more lymph node regions involved on the same side of the diaphragm

stage 3

lymph node regions involved on both sides of the diaphragm

stage 4

diffuse involvement of an organ that is not considered part of the lymphatic system (lung or liver)

radiation therapy, chemotherapy, or both

Stages I and II (limited disease) can be treated with

chemotherapy alone, or a combination of radiation therapy and chemotherapy

stage III is treated with

chemotherapy alone

stage IV (extensive disease) is most often treated with

radiation therapy

use of radiation or high-energy x-rays to kill cancer cells, keep them from growing or regrowing but may result to suppression of the immune system and blood count

chemotherapy

use of powerful drugs to kill cancer cells; may cause low WBC, RBC, and platelet count

• adriamycine

• bleomycin

• vinblastine

• dacarbazine

ABVD is an example of a chemotherapy drug for Hodgkin lymphoma, it stands for

transfusion of blood products

fight low platelet count and anemia

antibiotics

fight infection, especially if fever occurs

stem cell transplantation

patients own stem cells are harvested, stored, and returned after chemotherapy

biological therapy / immunotherapy

takes advantage of the body’s natural immunity against pathogens

monoclonal antibodies

Abs made in the lab to find and attach itself to a specific antigen; help kill tumor cells directly or indirectly

cytokines

naturally occurring chemicals or produced artificial life and administered in large doses

vaccines

do not prevent disease, rather stimulate the immune system to mount a specific response against cancer or create a memory of the cancer to prevent development of new tumor

men

are at greater risk for relapse

• interleukin 10

• interleukin 6

• soluble CD 30

serologic markers such as elevations of

leukemia, infertility, heart disease

possible complications in treatment

1. classic hodgkin — 95%

2. predominant hodgkin — 5%

2 main types of Hodgkin Disease

1. nodular sclerosing hodgkin lymphoma

2. mixed cellularity hodgkin lymphoma

3. lymphocyte depleted hodgkin lymphoma

4. lymphocyte-rich classic hodgkin

classic hodgkin 4 subtypes

1. nodular lymphocytes predominant hodgkin

2. diffuse lymphocyte predominant hodgkin

2 subtypes of predominant hodgkin

nodular sclerosing hodgkin lymphoma

• the most common type of hodgkin lymphoma and affects 60-80% of people in developed countries

• common in females and mostly affects younger people-adolescent and young adults

• birefringent collagenous sclerosis

• classic R-S crlls

• lacunar cell

histopathological features of NSHD

lacunar cell

a distinctive R-S variant cell

mixed cellularity hodgkin disease

• 15-30%

• all ages

• male = females

mixed cellularity hodgkin disease

affects abdomen and spleen, less likely the chest

nodular scelorsing hodgkin disease

disease mainly affects the nodes on the neck, armpits, and chest

mixed cellularity hodgkin disease

associated with those positive for HIV and EBV

heterogeneous mixture of cells: lymphocytes, histiocytes, plasma cells, eosinophils, R-S cells, and R-S variants

histopathological features or MCHD

lymphocyte depleted hodgkin disease

• very rare, 1%

• older people

• HIV sufferers/patients

• men

lymphocyte depleted hodgkin disease

affects abdomen and pelvis

• sparse lymphocytes

• irregular sclerosis

histopathological features of LDHD

lymphocyte-rich classic hodgkin disease

• uncommon, 5-6%

• males: 30s to 40s

• most are diagnosed in early stages and response to treatment is excellent

Reed-Sternberg cell in cellular and stromal background

histopathologic features of LRCHD

cellular and stromal background

bg that determines the subcategory to which the lesion belongs

nodular lymphocyte predominant hodgkin disease

• 5%

• 3x more common in men

• young adults: 30s-50s

nodular lymphocyte predominant hodgkin disease

affects peripheral lymph nodes (underarm, neck, ear, groin)

• large, circular meshwork of cell

• L&H cells

• popcorn cells

• B-cells, scattered T-cells

histopath features of NLPHD

diffuse lymphocyte predominant hodgkin disease

• extremely rare

• not well defined

spread-out arranged T-cells

histopath features of DLPHD

1. frequent handwashing

2. safe sex

3. not sharing of needles or other personal items

4. support groups

lymphoma prevention