Hey guys, how are things? I'm so excited today to continue our discussion on hematology.
And today, it's time.. for Hodgkin's lymphoma
As you know,
Hematological malignancies are leukemias, lymphomas, or myeloma
Lymphoma: is a solid tumor of the lymphatic system, or lymphoid tissue such as: lymph node, spleen
Mucosa-associated lymphatic tissue,...etc
Lymphoma is divided into Hodgkin's lymphoma, and non-Hodgkins lymphoma. Hodgkin's is less common than non-hodgkin's.
Hodgkins is a local disease, with Reed Sternberg cells.
So, imagine that the genie appeared to you and told you: "you have been cursed by a lymphoma"!
Which one should you choose? -Of course, You should choose...
Hodgkin's lymphoma, because it's less evil than non-Hodgkin's. your chance of
survival with Hodgkins is better than that with non-Hodgkins lymphoma.
Represents 40 percent of adult lymphoma. Commoner in males than females, with the exception of nodular sclerosing subtype.
remember roses for the female (Mnemonic: sclerosis = roses = female)
More common in Caucasian. Has bimodal age distribution;
The first peak is around 15 to 34 years of age and
the second peak; to patients older than 50 years of age.
Patients of Hodgkin's disease are usually younger than those of non-hodgkin's
So Hodgkin's is a disease of the young!
Usually starts in the cervical lymph nodes causing cervical lymph adenopathy, which is painless.
HIV patients have higher risk of Hodgkin's disease and
Hodgkin's is associated with a defect in cell mediated immunity
Did you know that exposure to benzene can lead to Hodgkin's lymphoma?
Exposure to benzene can lead to acute leukemia as well
Hodgkin's disease has a complication of causing acute lymphoblastic leukemia
Hodgkin's is associated with Epstein Barr virus
Hodgkin's is more common in patients with
History of mono because it makes perfect sense since infectious mononucleosis
is
with epstein-barr virus (EBV)
Contiguous spread is
common in Hodgkin's lymphoma.
Which means from this lymph node to this lymph node to the next lymph node to the next one node in the same local area
This is different from non Hodgkin's lymphoma,
Where there is distant spread.
There is lymphadenopathy in Hodgkin's, absolutely. It's localized and it's painless remember painful infection?
painless malignancy
Secondary amyloidosis; the serum amyloid A protein or SAA protein.
Hodgkin's
can be treated youth using
Radiation which will lead to non Hodgkin's so you're trying to treat Hodgkin's using radiation
But now you end up with non-Hodgkin's. Talking about misfortune!!!
The classification of Hodgkin's is nodular lymphocyte predominance or
Classic Hodgkin's. Classic Hodgkin's is more common
Classic Hodgkin's has four subtypes:
Nodular sclerosis is by far the most common; it's commoner in females
roses
lymphocyte rich, mixed cellularity
Lymphocyte depleted: they're the worst subtype. So let's talk more about these subtypes.
You have nodular lymphocyte predominance?
5% of cases and carries good prognosis
nodular sclerosis the most common subtype
Females more than males roses
women and
Children are the typical patients. It's the most common subtype of the classic Hodgkin's
Anterior mediastinal nodes are often involved.
It has an excellent prognosis...the best prognosis all of all of these are the nodules chlorosis.
It has the lacunar type reed Sternberg so which is a reed Sternberg sole variant
Lymphocyte rich, it's rich. So it carries very good prognosis
Lymphocyte depleted on the other hand it's depleted. So it has the poorest survival bad prognosis
it's the most aggressive of one and
Thankfully, it's the least common it's depleted. Okay
Mixed cellularity the name has the answer. It has more than one cell it has if Sinha fills plasma cells
histiocytes
etc a disease of the elderly
Abdominal lymph nodes and spleen are often involved
So remember nodular sclerosis commoner and females good prognosis lymphocyte
Rich, very good prognosis a lymphocyte depleted very bad prognosis mixed cellularity more than one cell
There is a genetic component to Hodgkin's disease
Nuclear factor Kappa light chain. It's is a transcription factor. It will undergo
Activation by epstein-barr virus or other factors now we turn the switch on
Genes that promote proliferation are now on leading to proliferation proliferation proliferation
proliferation which is cancer
Now, let's turn our attention to lymph adenopathy in Hodgkin's disease. It's localized
It's painless
It starts in the cervical nodes the supraclavicular and the interior
Mediastinal are also common. If you do a biopsy to this lymph node, and we use a core needle biopsy
Never use fine needle aspiration. We need a core needle biopsy for lymphoma
Ungrown appearance. You'll have bulging fish flesh appearance rubbery
inconsistency a good pathologist can
feel the lymph node and
Tell this is very rubbery
I can tell it's gonna be Hodgkin's it takes a slice put it under the microscope and Wow
Here we have the Reda Sternberg cell and we confirm the diagnosis of Hodgkin's lymphoma
That's a good pathologist that uses all of his senses to diagnose the disease and instead of just like a lab technician
Just reads rumors all therefore Hodgkiss. No medicine is an art
Microscopic appearance, there is Sternberg. So which are positive for CD 15 and CD 30?
Here's a side note. Did you know causes of mediastinal masses are the famous forties?
Thyroid mass thymoma
Teratoma and terrible lymphoma the terrible lymphoma is Hodgkin's which subtype?
Nodular sclerosis, and usually the patient is a female
Lymphoma in the mediastinum only too short of breath and dry cough. Clinically. We have lymph adenopathy
We have fever the fever comes the fever goes the fever comes the fever goes
Comes and goes in a cyclical manner we call this Pelle Epstein fever
itching is common splenomegaly, but not massive contrast that with
CML that had massive splenomegaly
nephrotic syndrome is common, especially
Minimal change disease think about it minimal change disease is a disease of the young
Hodgkin's disease the disease of the young they go together
Obstructive jaundice of lymph adenopathy involve that porta hepatis, which is the door of the liver
skin, erythema, nodosum
CNS cerebellar degeneration
autoimmune hemolytic anemia
Yes in Hodgkin's disease as well as CLL
Pain and lymph nodes on alcohol consumption is a very specific sign. It's not sensitive
It's not common, but it's very specific Epstein Barr virus can cause
Hodgkin's disease as well as non-hodgkins lymphoma it
commonly causes
non-hodgkins lymphoma even more than Hodgkin's
cancer caused by EBV nasopharyngeal carcinoma
Burkitt's lymphoma Hodgkin's lymphoma primary CNS lymphoma post organ transplant lymphoma the evil Epstein Barr
So today we have finished talking about Hodgkins in the next videos. We will talk about diagnosis and treatment reached cerebrum
So mnemonic about Hodgkins case not only one case but 10 cases
Or 10 questions on Hodgkins then a quick review
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Stay happy and study hard medicos is perfection Alice