welcome to part 2 for lymphoma we could talk about Hodgkin's lymphoma
Hodgkin's lymphoma is second in our discussion today so let's get started
first we gotta know how to spell Hodgkin's lymphoma and I guess if there
was a lymphoma that you were going to get if you had no choice this would be
the one to get because the prognosis is usually a bit better there's a couple of
points to point out about Hodgkin's lymphoma there's a special type of cell
that we see in Hodgkin's lymphoma it's called a read stern books
burg cell reinstall burg and the other way of thinking about these are allies
you'll see these things on a cell and you'll see some clearing around it
almost nonetheless allies so these reads Sternberg cells the point here is that
these read Sternberg cells are olympos sites and here's a key point they can
either be T or B cells they may test you on that
so can read Strindberg's beasts T cells or B cells the answer is yes and really
it can spread to any part of the body if left long enough but the the key problem
with Hodgkin's lymphoma is not the Reedsburg cells but actually it is a
failure of T cell function okay so what's another disease that is a failure
of T cell function HIV okay but this is not HIV this is a Hodgkin's lymphoma but
you've got a failure of T cell function but these read Sternberg cells that you
can see can either be T cells or B cells and they can spread basically anywhere
in the human body if left for long enough okay so what about staging there
are basically four stages there's stage 1 or stage 2 stage 3 and stage 4 and
these have to do with where we see the lymph nodes basically Stage 1 means
that we see nodes and there's one node okay
stage two is that there are two or more nodes on the same side of the diaphragm
so if we divide the body up and we've got the diaphragm that there's two nodes
and they just happen to be on the same side of the diaphragm
Stage three means that there are two nodes and they are on different sides of
the diaphragm and then finally stage four means that it's well basically its
disseminated everywhere and then there is two types of symptoms I'm sorry
there's two types of stages in addition to that which is a and B you'll have
stage one a or two a or three a or four eights that are a means that there are
no symptoms and then B means that there are symptoms okay so this is where we
get the term B symptoms from what are B symptoms these are like constitutional
symptoms like fevers night sweats chills fatigue these types of things so you
could have a 3 B or 2a this is basically how the staging is done staging is not
that accurate in terms of prognosis it's more of the grade of the Hodgkin's
lymphoma which we're going to talk about which determines more the prognosis okay
so I want to divide the different types of Hodgkin's lymphoma by the way
Hodgkin's lymphoma makes up only about 15% of all of the different types of
lymphoma we talked about non Hodgkin's in the first lecture
now we're talking about Hodgkin's only 15% of all of the lymphomas are
Hodgkin's lymphoma so we're going to kind of divide up the the page here into
the different types of Hodgkin's lymphoma and this is a way that we can
do it so we can compare and contrast the different types of Hodgkin's lymphoma
so the first thing we're going to do is talk about the name of these different
types of Hodgkin's lymphoma and what we have is we have something called a
lymphocyte predominant we have a mixed cellularity we have a lymphocyte
depleted and we have something called nodular sclerosis so lymphocyte
predominant mixed cellularity lymphocyte depleted and nodular sclerosis now what
do these things mean well simply put we're looking at the number of
lymphocytes that we see on the slide if there's not a lot of lymphocytes then it
would be a lymphocyte depleted if there are a lot of lymphocytes it would be a
lymphocyte predominant if it's kind of in the middle it would be mixed
cellularity and if we see nodular with a lot of collagen around the Reed
Sternberg cells that would be nodular sclerosis so that's kind of the
histological description of that what about the predominance or the prevalence
so how often do we see a lymphocyte predominant it actually only makes up
about 5% of all of the Hodgkin's lymphoma Mik cellularity is 30%
lymphocyte depleted is 5% and by far the most common is nodular sclerosis 60% of
the Hodgkin's lymphoma now next thing to look at is the the age so typically what
age are we seeing these patients at and typically the lymphocyte predominance is
in the younger age group so we'll put young mix cellularity is in the middle
age group whereas lymphocyte depleted is typically old and nodular sclerosis is
young females
okay the next category that distinguishes these four different types
is the read Sternberg sells read stromberg cells in lymphocyte
predominate is few whereas in mixed cellularity it's moderate and in
lymphocyte depleted there's quite a bit of them in nodular sclerosis it can be
variable but we see collagen around it that's where they get the nodular
sclerosis part from and there are clear spaces around the read stromberg cells
now the next thing and the second the last thing we want to talk about is
where in the body we do we see it so the position so lymphocyte predominant I'm
going to draw my little funny man here so we can see typically where we see and
I'll draw that on all of these here so we can sort of go through it here one by
one
so we're looking at where in the body do we see these lymph nodes and the
lymphocyte predominant typically we see them cervical so I put here by the neck
and also inguinal in the MEC cellularity however we see cervical we also see in
the chest or the mediastinum and we also see it in inguinal as or actually we see
it more in the abdominal area okay in lymphocyte depleted we really only see
it in the retroperitoneal area or in the viscera so abdominal once again and
finally in nicks in in nodular sclerosis we see it there in the cervical and in
the mediastinal area or in the chest so that kind of gives you a overview here
of of the type of distribution that we see that in now in terms of cure rates
interestingly the lymphocyte predominant has a 90 percent cure rate whereas the
mix cellularity has a seventy-five percent cure rate by the way these are
better than the non hodgkins the lymphocyte depleted has the worst
prognosis of all at only 45 percent whereas the nodular sclerosis has a
pretty good rate of about 85 percent now a couple things I want you to note here
and that is as the age gets older so does the basically the cure rate goes
down and as the amount of reads Sternberg cells goes up the cure rate
also goes down so the less reads Sternberg's you sent you have the better
the prognosis the older you are the worst of prognosis so these are
basically the four different types of Hodgkin's lymphoma again the read
Sternberg cell is as part of this it can either be a t cell or b cell generally
speaking Hodgkin's lymphoma is a failure of T cell
function remember that epstein-barr virus is a dysfunction of the B cell
staging is generally inaccurate in terms of prognosis but it has to do with how
many nodes are in different sides of the diaphragm you can divide up this staging
into a and B being fevers night sweats weight loss etc a being no symptoms then
we've got the different actual grades of Hodgkin's lymphoma which is lymphocyte
predominant mix cellularity lymphocyte depleted and nodular sclerosis and i
have summarized here how they differ so that concludes the second half here of
lymphoma thank you for joining us