{"id":5349,"date":"2021-05-15T23:53:42","date_gmt":"2021-05-15T21:53:42","guid":{"rendered":"https:\/\/meddists.com\/learn\/clinical\/hematology\/hematological-oncology\/hodgkins-lymphoma\/"},"modified":"2022-02-13T02:30:08","modified_gmt":"2022-02-13T00:30:08","slug":"hodgkins-lymphoma","status":"publish","type":"page","link":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/hematology\/oncological-disorders\/lymphomas\/hodgkins-lymphoma\/","title":{"rendered":"Hodgkin&#8217;s lymphoma"},"content":{"rendered":"<span class=\"block-heading\" id=\"header_1\">\n<h4 class=\"wp-block-heading\" id=\"introduction\" class=\"wp-block-heading\" id=\"introduction\" class=\"title_collection title1\">Introduction<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_1\">\n\n\n<p class=\"wp-block-paragraph\"><strong>Hodgkin\u2019s disease<\/strong> or <strong>Hodgkin\u2019s lymphoma (HL)&nbsp;<\/strong>refers to a group of unusual B-cell lymphomas that are characterized by the presence of a specific cell type &#8211; <strong>Reed-Sternberg (RS) cell<\/strong>.<\/p>\n\n\n\n<ul class=\"wp-block-list\" id=\"block-94660ec6-da73-4a1c-ae9b-d707dd582b96\"><li>Accounts for 40% of adult lymphomas. Appears mostly in adults, and more in men.<\/li><li>As with other lymphomas &#8212; the tumor cells are in the lymphatic tissues (not bone marrow)<ul><li>Specifically, the germinal centers<\/li><li><strong>Unlike NHL<\/strong>, usually a <strong>single<\/strong> lymph node or lymph node group are involved<\/li><\/ul><ul><li>Spreads from one lymph node to the other (contiguity)<\/li><li>Painless swelling of the lymph nodes can be seen<\/li><\/ul><\/li><li>Easy diagnosis &#8212; a presence of RS cells<ul><li>They are the tumor cells &#8212; the nearby lymphocytes are not malignant<\/li><\/ul><\/li><li>Chromosome 9 abnormalities often seen<\/li><li>Involved with Epstein-Barr Virus (EBV)<\/li><li>Relatively good prognosis.<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_2\">\n<h4 class=\"wp-block-heading\" id=\"comparison-with-nhl\" class=\"wp-block-heading\" id=\"comparison-with-nhl\" class=\"title_collection title1\">Comparison with NHL<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_2\">\n\n\n<figure class=\"wp-block-table is-style-stripes\"><table class=\"pure-table\"><thead><tr><th><\/th><th><strong>Hodgkin&#8217;s lymphoma<\/strong><\/th><th><strong>Non-Hodgkin&#8217;s Lymphoma<\/strong><\/th><\/tr><\/thead><tbody><tr><td>Location<\/td><td>Single lymph node or group<\/td><td>Frequently multiple nodes are involved<\/td><\/tr><tr><td>Spread<\/td><td>From one node to the other (contiguity)<\/td><td>Diffuse (non-contiguity)<\/td><\/tr><tr><td>Mesenteric nodes and Waldeyer&#8217;s ring involvement<\/td><td>Rare<\/td><td>Common<\/td><\/tr><tr><td>Extranodal involvement<\/td><td>Rare<\/td><td>Common<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n<\/span><span class=\"block-heading\" id=\"header_3\">\n<h4 class=\"wp-block-heading\" id=\"reed-sternberg-rs-cells\" class=\"wp-block-heading\" id=\"reed-sternberg-rs-cells\" class=\"title_collection title1\">Reed-Sternberg (RS) cells<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_3\">\n\n\n<p class=\"wp-block-paragraph\">RS cells are huge B-cell-derived cells with a large, multilobed nucleus and prominent nucleoli, giving an &#8220;owl eye&#8221; appearance. These cells are the tumor cells that characterize Hodgkin&#8217;s lymphomas &#8212; the nearby lymphocytes are <strong>not<\/strong> malignant.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Other cells include Hodkin and Lacunar (&#8220;popcorn&#8221;-like) cells typically appearing in NLPHL (see below).<\/p>\n\n\n<\/span><span class=\"block-heading\" id=\"header_4\">\n<h4 class=\"wp-block-heading\" id=\"classification\" class=\"wp-block-heading\" id=\"classification\" class=\"title_collection title1\">Classification<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_4\">\n\n\n<ul class=\"wp-block-list\" id=\"block-94660ec6-da73-4a1c-ae9b-d707dd582b96\"><li>Classical (cHL)<ul><li><strong>Nodular sclerosis<\/strong> (most common)<\/li><li><strong>Mixed cellularity<\/strong><\/li><li><strong>Lymphocyte-rich<\/strong><\/li><li><strong>Lymphocyte-depleted<\/strong><\/li><\/ul><\/li><li>&#8220;Non-classical&#8221;<ul><li><strong>Nodular lymphocyte-predominant<\/strong> (NLPHL)<ul><li>Differs from cHL by immunophenotype and clinical features<\/li><\/ul><\/li><\/ul><\/li><\/ul>\n\n\n\n<figure class=\"wp-block-table is-style-stripes\"><table class=\"pure-table\"><thead><tr><th><\/th><th><strong>cHL<\/strong><\/th><th><strong>NLPHL<\/strong><\/th><\/tr><\/thead><tbody><tr><td>Age<\/td><td>Bimodal<\/td><td>Unimodal<\/td><\/tr><tr><td>Location<\/td><td>Deep nodes<\/td><td>Superficial nodes<\/td><\/tr><tr><td>Neoplastic cells<\/td><td>RS cells<\/td><td>Lacunar &amp; Hodgkin (popcorn) cells<\/td><\/tr><tr><td>Surrounding lymphocytes<\/td><td>Mainly T-lymphocytes<\/td><td>Mainly B-lymphocytes<\/td><\/tr><tr><td>Specific immunophenotypes<\/td><td>CD15+, CD30+, BCL2+, LCA-<\/td><td>CD15-, CD30-, BCL2-, LCA+<\/td><\/tr><tr><td>Association with EBV<\/td><td>Common<\/td><td>Uncommon<\/td><\/tr><tr><td>Treatment<\/td><td>Curable<\/td><td>Indolent but relapses<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n<\/span><span class=\"block-heading\" id=\"header_5\">\n<h4 class=\"wp-block-heading\" id=\"clinical-manifestration\" class=\"wp-block-heading\" id=\"clinical-manifestration\" class=\"title_collection title1\">Clinical manifestration<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_5\">\n\n\n<ul class=\"wp-block-list\"><li>Begins with a single swollen and non-tender lymph node<\/li><li>&#8220;B-symptoms&#8221;: fever, night sweats, weight loss, although less common than in NHL<\/li><li>Hepatosplenomegaly<\/li><li>Pain after alcohol consumption<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_6\">\n<h4 class=\"wp-block-heading\" id=\"diagnosis\" class=\"wp-block-heading\" id=\"diagnosis\" class=\"title_collection title1\">Diagnosis<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_6\">\n\n\n<ul class=\"wp-block-list\"><li><strong>CBC<\/strong><\/li><li><strong>ESR<\/strong><\/li><li><strong>Lymph node biopsy <\/strong>(fine-needle aspiration is insufficient; demonstration of RS cells + immunohistochemistry)<\/li><li><strong>Imaging<\/strong> (x-ray, PET-CT)<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_7\">\n<h4 class=\"wp-block-heading\" id=\"staging\" class=\"wp-block-heading\" id=\"staging\" class=\"title_collection title1\">Staging<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_7\">\n\n\n<ul class=\"wp-block-list\"><li>Stage I (single node region)<\/li><li>Stage II (two or more lymph node regions on the same side of the diaphragm)<\/li><li>Stage III (lymph nodes on both sides of the diaphragm)<\/li><li>Stage IV (stage III + extra-lymphatic tissues are involved)<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_8\">\n<h4 class=\"wp-block-heading\" id=\"prognosis\" class=\"wp-block-heading\" id=\"prognosis\" class=\"title_collection title1\">Prognosis<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_8\">\n\n\n<p class=\"wp-block-paragraph\">The prognosis of the disease depends on the stage, age, number of affected regions, size of the tumor, and blood parameters. From stage II and onwards, a scoring system is used (0-7 points; where 7 points are the worst prognosis).<\/p>\n\n\n<\/span><span class=\"block-heading\" id=\"header_9\">\n<h4 class=\"wp-block-heading\" id=\"treatment\" class=\"wp-block-heading\" id=\"treatment\" class=\"title_collection title1\">Treatment<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_9\">\n\n\n<ul class=\"wp-block-list\"><li>cHL<ul><li>2-6 cycles of ABVD: Adriamycin, bleomycin, vinblastine, dacarbazine<\/li><\/ul><\/li><li>NLPHL<ul><li>If stage I: radiotherapy alone<\/li><li>If stage II and above: 2-6 cycles of ABVD + radiotherapy<\/li><\/ul><\/li><li>In the case of relapse:<ul><li>DHAP chemotherapy + stem cell transplantation<\/li><li>Anti-CD30 mAb (brentuximab vedotin)<\/li><li>PD1 inhibitors (nivolumab or pembrolizumab)<\/li><\/ul><\/li><\/ul>\n<\/span><div id=\"the_titles\" style=\"display:none;\"><h4 class=\"wp-block-heading\" id=\"introduction\" class=\"wp-block-heading\" id=\"introduction\">Introduction<\/h4><h4 class=\"wp-block-heading\" id=\"comparison-with-nhl\" class=\"wp-block-heading\" id=\"comparison-with-nhl\">Comparison with NHL<\/h4><h4 class=\"wp-block-heading\" id=\"reed-sternberg-rs-cells\" class=\"wp-block-heading\" id=\"reed-sternberg-rs-cells\">Reed-Sternberg (RS) cells<\/h4><h4 class=\"wp-block-heading\" id=\"classification\" class=\"wp-block-heading\" id=\"classification\">Classification<\/h4><h4 class=\"wp-block-heading\" id=\"clinical-manifestration\" class=\"wp-block-heading\" id=\"clinical-manifestration\">Clinical manifestration<\/h4><h4 class=\"wp-block-heading\" id=\"diagnosis\" class=\"wp-block-heading\" id=\"diagnosis\">Diagnosis<\/h4><h4 class=\"wp-block-heading\" id=\"staging\" class=\"wp-block-heading\" id=\"staging\">Staging<\/h4><h4 class=\"wp-block-heading\" id=\"prognosis\" class=\"wp-block-heading\" id=\"prognosis\">Prognosis<\/h4><h4 class=\"wp-block-heading\" id=\"treatment\" class=\"wp-block-heading\" id=\"treatment\">Treatment<\/h4><\/div>","protected":false},"excerpt":{"rendered":"<p>Introduction Hodgkin\u2019s disease or Hodgkin\u2019s lymphoma (HL)&nbsp;refers to a group of unusual B-cell lymphomas that are characterized by the presence of a specific cell type &#8211; Reed-Sternberg (RS) cell. Accounts for 40% of adult lymphomas. Appears mostly in adults, and more in men. As with other lymphomas &#8212; the tumor cells are in the lymphatic [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":5478,"menu_order":2,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-5349","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Hodgkin&#039;s lymphoma &#8211; Meddists<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/hematology\/oncological-disorders\/lymphomas\/hodgkins-lymphoma\/\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"2 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/hematology\\\/oncological-disorders\\\/lymphomas\\\/hodgkins-lymphoma\\\/\",\"url\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/hematology\\\/oncological-disorders\\\/lymphomas\\\/hodgkins-lymphoma\\\/\",\"name\":\"Hodgkin's lymphoma &#8211; 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