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Slide 1 :
Lymphoma HODGKIN LYMPHOMA
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HODGKIN’S LYMPHOMA Hodgkin's lymphoma, previously known as Hodgkin's disease, is a type of lymphoma, which is a type of cancer originating from white blood cells called lymphocytes. Hodgkin's lymphoma is characterized by the orderly spread of disease from one lymph node group to another, and by the development of systemic symptoms with advanced disease. The disease is characterized by the presence of Reed-Sternberg cells (RS cells) on microscopic examination. Hodgkin's lymphoma is a cancer of lymph tissue found in the lymph nodes, spleen, liver, bone marrow, and other sites Incidence: The disease occurrence shows two peaks: the first in young adulthood (age 15–35) and the second in those over 55 years old More prevalent in young adult males than females The survival rate is generally 90% or higher when the disease is detected during early stages
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Causes The first sign of this cancer is often an enlarged lymph node which appears without a known cause. The disease can spread to nearby lymph nodes. Later it may spread to the spleen, liver, bone marrow, or other organs. The cause is not known. Hodgkin's lymphoma is most common among people ages 15 - 35 and 50 - 70. Infection with the Epstein-Barr virus (EBV) is thought to contribute to most cases.
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Pathogenesis RS cells, although are the real neoplastic cells in HL, there exists considerable debate about their nature and origin. And also their no. is too less about only 5%. What stimulates these lymphoid cells to undergo transformation???.... Possiblilities include: EBV( Epstein-Barr virus): on the basis of epidemiological and serological studies. Genetic etiology: on the basis of observation of occurrence of HL in families. Cytokines: presence of reactive inflammatory cells is due to secretion of cytokines from RS cells e.g. IL-5(GF for eosinophils), IL-13(for autocrine stimulation of RS cells), & TGF-B(for fibrogenesis).
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NEW WHO CLASSIFICATION Two broad classes: Classical subtype: include first 4 subtype of Rye classification viz Nodular sclerosis Mixed cellularity Lymphocyte-rich Lymphocyte depletion Lymphocyte predominance : newer one
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Hodgkin lymphoma: A binucleate Reed-Sternberg cell with large, inclusion-like nucleoli and abundant cytoplasm is surrounded by lymphocytes, and an eosinophil can be seen below; an owl-eye appearance
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Hodgkin lymphoma, nodular sclerosis type. A distinctive "lacunar cell" with multilobed nucleus containing many small nucleoli is seen lying within a clear space created by retraction of its cytoplasm. It is surrounded by lymphocytes. Lacunar cells are a feature of nodular sclerosis Hodgkin lymphoma and are not found in other subtypes
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Hodgkin disease, mixed-cellularity type. Classic RS cells are plentiful within a distinctive heterogeneous cellular infiltrate, which includes small lymphocytes, eosinophils (bright-red cytoplasm), plasma cells, and benign histiocytes
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Hodgkin disease, Lymphocyte depletion type. Numerous atypical cells are present in a densely fibrotic stroma. Lymphocytes are scanty.
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Lymphocyte-rich classic Hodgkin's disease. Reed-Sternberg cells and mononuclear Hodgkin's cells are relatively rare within the background proliferation of small lymphocytes and histiocytes
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Fig. Lymphocyte predominance Hodgkin's lymphoma. High-power view showing the lymphocytic and/or histiocytic (L&H) type of cell (‘popcorn’ cell) that is characteristic of this condition. Within the background of lymphocytes and histiocytes are scattered large lobated cells having a fine chromatin pattern, relatively small nucleoli, and sparse cytoplasm æ so-called L and H cells.
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Symptoms: Fatigue, Fever and chills, Itching, Loss of appetite, Night sweats, Painless swelling of the lymph nodes in the neck, armpits, or groin (swollen glands), Weight loss Other symptoms that may occur with this disease: Clubbing of the fingers or toes, Excessive sweating, Flank pain, Hair loss, Neck pain, Pain in the affected areas after drinking alcohol, Skin blushing or flushing, Splenomegaly.
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Exams and Tests (diagnosis): The disease may be diagnosed after: Biopsy of suspected tissue Bone marrow biopsy Lymph node biopsy Detection of Reed-Sternberg (Hodgkin's lymphoma) cells by biopsy from any site
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Staging: After Hodgkin's lymphoma is diagnosed, a patient will be staged: that is, they will undergo a series of tests and procedures that will determine what areas of the body are affected Stage I: is involvement of a single lymph node region or single extralymphatic site ; Stage II: is involvement of two or more lymph node regions on the same side of the diaphragm or of one lymph node region and a contiguous extralymphatic site; Stage III: is involvement of lymph node regions on both sides of the diaphragm, which may include the spleen and/or limited contiguous extralymphatic organ or site ; Stage IV: is disseminated involvement of one or more extralymphatic organs
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Treatment: Treatment primarily depends on the following: The type of Hodgkin's lymphoma (most people have classic Hodgkin's) The stage (where the disease is found) Whether the tumor is more than 4 inches (10 cm) wide The patient's age and other medical issues Other factors, including weight loss, night sweats, and fever Treatment varies with the stage of the disease. The best treatment for an individual patient depends on many factors, and should be discussed with a doctor who has experience treating this disease. Stages I and II (limited disease) can be treated with local radiation therapy, chemotherapy, or a combination of both. Stages III and IV (extensive disease) are treated with chemotherapy alone or a combination of radiation therapy and chemotherapy.
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Outlook (Prognosis): With the right treatment, more than 80% of people with stage I or II Hodgkin's lymphoma survive for at least 10 years. If the disease has spread, the treatment is more intense and the 5-year survival rate is about 60%. Possible Complications: Inability to have children (infertility), Liver failure, Lung problems, Other cancers Side effects of radiation and chemotherapy Chemotherapy can cause low blood cell counts, which can lead to an increased risk of bleeding, infection, and anemia. To minimize bleeding, apply ice and pressure to any external bleeding. Use a soft toothbrush and electric razor for personal hygiene. Infection should always be taken seriously during cancer treatment. Contact your doctor immediately if you develop fever or other signs of infection. Planning daily activities with scheduled rest periods may help prevent fatigue associated with anemia.
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When to Contact a Medical Professional. Call your health care provider if: 1) You have symptoms of Hodgkin's lymphoma 2) You are being treated for Hodgkin's lymphoma and you experience side effects of radiation and chemotherapy, including nausea, loss of appetite, vomiting, diarrhea, fever, or bleeding Alternative Names: We can also call this disease as: 1) Lymphoma - Hodgkin's; 2) Hodgkin's disease; 3) Cancer - Hodgkin's lymphoma
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