Hodgkin Lymphoma Case Study

Hodgkin Lymphoma: A Case Study

• Patient Case Overview: A 30-year-old male presented with a painless, enlarged lymph node in the right cervical region, persisting for two months. He experienced fatigue, intermittent fevers, and night sweats. Physical examination revealed firm, non-tender lymphadenopathy. Biopsy confirmed Hodgkin lymphoma, with involvement limited to the neck and chest. Treatment options, including chemotherapy and radiotherapy, were discussed.

Short Essay Questions

• Epidemiology and Risk Factors: Hodgkin lymphoma is more common in young adults, especially males, and may be associated with Epstein-Barr virus (EBV) infection and family history.

• Pathophysiology and Treatment Implications: The pathophysiology involves the transformation of B lymphocytes, leading to the characteristic Reed-Sternberg cells. This impacts treatment response as different types of Hodgkin lymphoma have varying responses to different treatments.

• Staging System and Clinical Significance: The Ann Arbor staging system, ranging from I to IV, is used to determine the extent of the disease, influencing treatment decisions and prognosis. Staging considers the location and spread of lymph nodes.

• First-Line Treatment Options: First-line treatments typically include ABVD chemotherapy, which may be supplemented with radiation therapy, depending on the stage of the disease.

• Follow-Up and Surveillance: Regular follow-up is crucial to monitor recurrence and manage long-term effects of treatment, including secondary malignancies.

Multiple Choice Questions

• Classic Histological Finding: Reed-Sternberg cells are a classic histological finding in Hodgkin lymphoma.

• EBV Association: Nodular sclerosis is the Hodgkin lymphoma subtype most commonly associated with EBV infection.

What is the most common initial presentation of Hodgkin lymphoma in patients?

• Painless lymphadenopathy

Which stage of Hodgkin lymphoma involves two or more lymph node regions above the diaphragm?

• Stage II

What is the role of PET-CT in the management of Hodgkin lymphoma?

• Staging and treatment response evaluation

Which chemotherapy regimen is the standard first-line treatment for Hodgkin lymphoma?

• ABVD

Which symptom is considered a “B symptom" in Hodgkin lymphoma?

• Night sweats

What factor significantly improves prognosis in early-stage Hodgkin lymphoma?

• Absence of B symptoms

Which immune checkpoint inhibitor is used for relapsed Hodgkin lymphoma treatment?

• Pembrolizumab

Which subtype of Hodgkin lymphoma has the best overall prognosis?

• Nodular sclerosis

Case Scenario

• A 30-year-old male presented with a painless, enlarged lymph node in the right cervical region, persistent for two months. He also reported fatigue, intermittent fevers, frequent night sweats, and a 5% unintentional weight loss over the past month. Physical examination revealed firm, non-tender lymphadenopathy.

Clinical Examination

• Vital Signs: Blood pressure 120/80 mmHg, heart rate 80 beats per minute, temperature 37.8°C
• Physical Examination: Enlarged, non-tender lymph nodes palpable in the cervical region, no hepatosplenomegaly.

Analysis of the case

• Possible causes of lymphadenopathy in a young adult
• Importance of thorough clinical examination in lymphadenopathy cases
• Factors distinguishing Hodgkin lymphoma from other lymphomas and non-malignant causes
• Diagnostic tests to confirm Hodgkin lymphoma and determine staging

Evaluation of Lymphadenopathy

• Age (less than 30: benign; older than 50: more malignant)
• Location (examine drainage areas; generalized lymphadenopathy suggests systemic disease)
• Associated symptoms (presence or absence of splenomegaly)
• Duration (longer duration may indicate chronic infection or indolent cancer)
• Physical examination (size, pain/tenderness, consistency)

Matting

• Benign or malignant, location is considered to determine whether it's malignant

Preliminary Assessment

• Painless lymphadenopathy + B symptoms = high suspicion for Hodgkin lymphoma
• Other possible diagnoses include non-Hodgkin lymphoma and infectious/inflammatory causes.

B symptoms

• Fever (unexplained fevers above 38°C)
• Night sweats (require a change of bedclothes)
• Weight loss (unintentional, 10% of body weight in 6 months or less)

Diagnostic Workup

• Complete blood count (CBC)
• Erythrocyte sedimentation rate (ESR)
• Lactate dehydrogenase (LDH)
• Chest X-ray and CT scan of the neck and chest
• Excisional biopsy of the enlarged lymph node
• Referral to an oncologist for management, possible bone marrow biopsy, and PET scan.

Lab Results

• CBC: Mild anemia and lymphopenia
• ESR: Elevated
• Biochemical tests: Liver and renal function tests within normal limits

Microscopic Findings

• Reed-Sternberg cells are distinctive neoplastic giant cells, often appearing with a "owl-eye" appearance.
• Different variants of Reed-Sternberg cells (mononuclear, lacunar, lymphohistocytic) are associated with various subtypes of Hodgkin lymphoma.

Hodgkin Lymphoma Classification

• Classical Hodgkin lymphoma subtypes (Nodular sclerosis, Mixed cellularity, Lymphocyte-rich, Lymphocyte-depleted)
• Nodular lymphocyte-predominant Hodgkin lymphoma

Staging

• Ann Arbor staging system (stages I-IV)

Prognosis

• Depends on the patient's age, clinical stage, and absence of B symptoms (presence may indicate more advanced stages).

Differences Between Hodgkin and Non-Hodgkin Lymphomas

• Incidence, sites, distribution
• Microscopic appearance (Reed-Sternberg cells, other features).