Hodgkin Lymphoma 

What is Lymphoma ? Lymphomas are a group of diseases caused by malignant lymphocytes that accumulate in lymph nodes and other lymphoid tissue and cause the characteristic clinical feature of lymphadenopathy.

Hodgkin lymphomA is potentially curable lymphoma.

Incidence is higher in males than in females, 85% of cases affecting boys.

It has bimodal distribution; The initial peak is in young adults (15-34 years) and 2 nd peak in older adults (>55 years).

B-cell origin Risk factors for HL:

◼ Viral infections: EBV

◼ Autoimmune diseases Dr. Ahmed Eltntway-2022-2023

Diagnosis and histological classification The Reed-Sternberg cells

-Large, abnormal lymphocytes that may contain more than one nucleus (Owl Eye)

-Of B-cell origin, derived from germinal centers of lymph node but no longer able to produce antibodies.

-Express the CD30 and CD15

only 1-2% of the total tumor cell mass

Diagrammatic representation of the different cells seen histologically in HL.

• Classical Hodgkin's lymphoma.

• Nodular lymphocyte predominance Hodgkin's lymphoma.

Classical HL:

Nodular LP HL

1-Nodular sclerosis Hodgkin's lymphoma 2-Lymphocyte-rich classical Hodgkin's lymphoma 3-Mixed cellularity Hodgkin's lymphoma 4-Lymphocyte depletion Hodgkin's lymphoma.

Nodular lymphocyte predominance Hodgkin's lymphoma. Dr. Ahmed Eltntway-2022-2023

Clinical presentation ◼ Lymphadenopathy: ◼ Peripheral Lymphadenopathy (non-tender, firm, and rubbery in consistency), Cervical LN (60-80%), Axillary LN, Inguinal LN.

◼ Mediastinal lymphadenopathy: 60-70%. ◼ Typically spread in stepwise fashion to anatomical contiguous nodes ◼ Extra-nodal infiltration less than NHL ◼ B symptoms (Pel Ebstein Fever, Drenching sweating) ➢ Pel Ebstein fever: (relapsing fever) high grade fever for 1-2 weeks followed by afebrile period of 1-2 weeks ➢ Pruritus Diagnosing HL ◼ Biopsy is necessary to confirm the diagnosis ◼ Excisional biopsy when possible ◼ Core needle biopsy ◼ Sometimes insufficient (due to rarity of RS cells in an HL tumor) ◼ Fine Needle Aspiration ◼ Inadequate for diagnosis of HL ◼ No tissue architecture Hodgkin Lymphoma Work-up Labs:

CBC w/diff, ESR, LDH Metabolic Panel incl: LFT, Albumin, Creatinine Pregnancy Test HIV test/hepatitis B, C testing PET/CT (± diagnostic IV contrast CT) Dr. Ahmed Eltntway-2022-2023

Routine bone marrow not indicated (PET sensitive for bony disease) Consider bone marrow bx if cytopenias Echocardiogram, Pulmonary function testing Fertility discussion, smoking cessation Staging of HL

A = Absence of B symptoms.

B = Presence of B symptoms.

Treatment of Classical HL ◼ Treatment is with ◼ Chemotherapy alone or ◼ ABVD multiagent chemotherapy; A (Adriamycin = Doxorubicin), B (Bleomycin), V (Vinblastine), D (Dacarbazine) ± radiotherapy.

◼ A combination of chemotherapy with radiotherapy. ◼ Combination of chemotherapy with monoclonal antibody (brentuximab vedotin {anti CD 30}) ◼ Autologous Stem cell transplantation (ABMT).