Hodgkin's Lymphoma Overview

Hodgkin's Lymphoma

• Definition: Cancer derived from lymphocytes, notably featuring multinucleated Reed-Sternberg cells, a form of B lymphocyte.
• Aetiology:
  • Epstein-Barr virus (EBV) accounts for approximately 45% of cases.
  • Associated with immunodeficiencies (e.g., organ transplant, HIV, immunosuppressants).
  • Linked to autoimmune diseases such as systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), Sjögren's syndrome, and celiac disease.
• Classifications:
  • Classical Hodgkin’s Lymphoma (90%):
    • Nodular sclerosis is the most common subtype.
    • Mixed cellularity has a moderate prognosis.
    • Lymphocyte-depleted subtype has the worst prognosis.
    • Lymphocyte-rich subtype shows the best prognosis.
  • Nodular Lymphocyte Predominant HL (NLPHL) comprises 10% of cases.
• Signs and Symptoms:
  • Painless lymphadenopathy predominantly affecting cervical, axillary, and inguinal regions.
  • May present as a mediastinal mass, causing chest pain, cough, or shortness of breath.
  • Associated symptoms include fatigue and weakness.
  • B Symptoms:
    • Fever, significant weight loss, and night sweats are common.
    • Rare features include Pel-Ebstein fever (fluctuating fever lasting for weeks) and pain in lymph nodes after alcohol consumption.
    • Pruritus (itching) may also occur.
• Diagnosis:
  • Complete Blood Count: May reveal elevated/decreased white blood cells (WBCs), anemia, and eosinophilia (about 20%).
  • Histology: Identification of Reed-Sternberg cells through lymph node excision; fine needle biopsy often insufficient.
    • Reed-Sternberg cells are large, with binuclear, bilobed nuclei; they test positive for CD15/CD30.
  • Imaging:
    • X-Rays show masses and enlarged lymph nodes in the chest, abdomen, and pelvis.
    • Bone scintigraphy or PET-CT is used to assess bone infiltration and disease progression.
• Differentials: Must be considered to differentiate from other lymphomas.
• Treatment: Primarily utilizes a combination of chemotherapy and radiotherapy, specifically the ABVD regimen (Adriamycin, bleomycin, vinblastine, dacarbazine).
• Prognosis: Generally favorable, with a 5-year survival rate of approximately 80-90%, exceeding 90% in children.

Non-Hodgkin's Lymphoma

• Definition: Cancer arising from all lymphocytes except Reed-Sternberg cells.
• Aetiology:
  • Commonly associated with chromosomal translocation t(14;18).
  • Infections, particularly EBV, HIV, HTLV-1, hepatitis C virus (HCV), and H. pylori, contribute to risk.
  • Linked to autoimmune disorders such as SLE, RA, and Sjögren's syndrome.
  • Environmental exposures, including benzene and radiation, are also implicated.
• Classifications:
  • T-Cell Lymphoma constitutes about 15% of cases.
  • B-Cell Lymphoma accounts for approximately 85%.
  • NK-Killer Lymphoma is a less common category.
• Signs and Symptoms:
  • Typically presents as painless lymphadenopathy, which is non-contagious.
  • Growth rates can vary: high-grade (fast growth) or low-grade (slow growth), often affecting cervical, axillary, or inguinal regions.
  • B Symptoms: Similar to Hodgkin’s lymphoma, include fever, weight loss, and night sweats.

Hodgkin's Lymphoma

• Represents 40% of lymphoma cases, known for a better prognosis.
• Originates from B lymphocytes, notably characterized by Reed-Sternberg cells (RS cells).
• Aetiology includes:
  • Epstein-Barr virus (EBV) in 45% of cases.
  • Immunodeficiencies due to organ transplants, HIV, immunosuppressive therapy, or chemotherapy.
  • Autoimmune diseases such as Systemic Lupus Erythematosus (SLE), Rheumatoid Arthritis (RA), Sjögren's syndrome, and celiac disease.
• Classifications comprise:
  • Classical Hodgkin's Lymphoma (90%), which includes:
    • Nodular sclerosis (most prevalent subtype).
    • Mixed cellularity.
    • Lymphocyte depleted (associated with a worse prognosis).
    • Lymphocyte-rich (associated with a better prognosis).
  • Nodular Lymphocyte Predominant Hodgkin Lymphoma (NLPHL) (10%).
• Signs and symptoms feature:
  • Painless lymphadenopathy commonly in cervical, axillary, and inguinal regions.
  • Mediastinal mass leading to chest pain, cough, and shortness of breath.
  • Accompanied by fatigue and weakness.
  • B symptoms include fever, weight loss, and night sweats.
  • Rarely, Pel-Ebstein fever causing fluctuating fever over weeks.
  • Uncommon alcohol-induced lymph node pain and pruritus.
• Diagnostic approaches include:
  • Complete Blood Count indicating elevated/decreased WBC, anemia, and 20% eosinophilia.
  • Histology requiring lymph node excision to identify RS cells, characterized by large, binuclear, bilobed nuclei and positivity for CD15/CD30.
  • Imaging via X-ray for detecting masses and enlarged lymph nodes, with bone scintigraphy or PET-CT assessing bone infiltration.
• Treatment utilizes a combination of chemotherapy and radiotherapy, specifically ABVD regimen (Adriamycin, bleomycin, vinblastine, and dacarbazine).
• Prognosis is favorable, with a 5-year survival rate around 80-90%, exceeding 90% in children.

Non-Hodgkin's Lymphoma

• Comprises 60% of lymphoma cases, generally associated with worse prognosis.
• Arises from various lymphocytes excluding Reed-Sternberg cells.
• Aetiological factors include:
  • Most common chromosomal translocation t(14;18).
  • Infections linked to EBV, HIV, HTLV-1, HCV, and Helicobacter pylori.
  • Autoimmune diseases such as SLE, RA, Sjögren's syndrome, and celiac disease.
  • Immunodeficiencies and environmental exposures like benzene and radiation.
• Classifications feature:
  • T-Cell Lymphoma (15%).
  • B-Cell Lymphoma (85%).

Hodgkin's Lymphoma

• Definition: Cancer originating from lymphocytes, particularly Reed-Sternberg cells (RS cells), a variant of B lymphocytes.
• Aetiology:
  • Epstein-Barr virus (EBV) involved in approximately 45% of cases.
  • Risk factors include immunodeficiencies (e.g., organ transplant patients, HIV, chemotherapy) and autoimmune diseases (lupus, rheumatoid arthritis, Sjogren's syndrome, celiac disease).
• Classifications:
  • Classical Hodgkin's Lymphoma (90% of cases):
    • Nodular sclerosis is the most prevalent subtype.
    • Other subtypes: mixed cellularity, lymphocyte depleted (associated with a worse prognosis), lymphocyte-rich (associated with a better prognosis).
  • Nodular Lymphocyte Predominant Hodgkin Lymphoma (NLPHL) accounts for 10% of cases.
• Signs and Symptoms:
  • Painless lymphadenopathy is common, notably in cervical, axillary, and inguinal areas.
  • Malignant lymphadenopathy can cause mediastinal masses leading to chest pain, cough, and shortness of breath.
  • B symptoms include fever, weight loss, and night sweats.
  • Pel-Ebstein fever is a rare cyclical fever pattern lasting weeks.
  • Alcohol-induced pain in lymph nodes is very rare but notable.
  • Pruritus (itching) may occur.
• Diagnosis:
  • Complete Blood Count may reveal elevated or decreased WBCs, anemia, and eosinophilia (20% occurrence).
  • Histological analysis identifies Reed-Sternberg cells; a lymph node excision is needed for sufficient biopsy material.
  • Imaging techniques include X-Ray for detecting masses and enlarged lymph nodes, and PET-CT or bone scintigraphy to assess bone involvement.
• Differentials: Not specified but typically includes other lymphomas and lymphoproliferative disorders.
• Treatment: Chemotherapy combined with radiotherapy, commonly utilizing ABVD regimen (Adriamycin, bleomycin, vinblastine, dacarbazine).
• Prognosis: Strong prognosis with a 5-year survival rate of approximately 80-90%; >90% for children.

Non-Hodgkin's Lymphoma

• Definition: Cancer arising from lymphocytes other than Reed-Sternberg cells.
• Aetiology:
  • Most common chromosomal translocation is t(14;18).
  • Associated infections include EBV, HIV, HTLV-1, HCV, and Helicobacter pylori.
  • Risk factors encompass autoimmune diseases, immunodeficiencies, and environmental agents like benzene and radiation.
• Classifications:
  • T-Cell Lymphoma (15%).
  • B-Cell Lymphoma (85%).
  • NK-Killer Lymphoma as another subtype.
• Signs and Symptoms:
  • Painless lymphadenopathy, which is not contagious, may be high grade (fast-growing) or low grade (slow-growing), primarily in cervical, axillary, or inguinal regions.

Hodgkin's Lymphoma

• Originates from lymphocytes, characterized by multinucleated Reed-Sternberg (RSC) cells, a type of B lymphocyte.
• Aetiological factors include Epstein-Barr virus (EBV) in approximately 45% of cases, immunodeficiencies (e.g., due to organ transplants or HIV), and autoimmune diseases like SLE and RA.
• Classified into two main types:
  • Classical (90%): Includes nodular sclerosis (most prevalent), mixed cellularity, lymphocyte depleted (worst prognosis), and lymphocyte-rich (best prognosis).
  • Nodular Lymphocyte Predominant HL (NLPHL) (10%).
• Common signs include painless lymphadenopathy in cervical, axillary, and inguinal regions, with potential malignant spread.
• Additional symptoms:
  • Mediastinal mass causing chest pain, cough, and shortness of breath.
  • B symptoms: fever, night sweats, and weight loss.
  • Pruritus and rare occurrences of alcohol-induced pain in lymph nodes.
• Diagnosis involves complete blood count, histology (RSC detection via lymph node excision), and imaging (X-ray, bone scintigraphy, PET-CT).
• Treatment often involves a combination of chemotherapy and radiotherapy using ABVD regimen (Adriamycin, bleomycin, vinblastine, dacarbazine).
• Good prognosis with a 5-year survival rate around 80-90%, exceeding 90% in children.

Non-Hodgkin's Lymphoma

• Different from Hodgkin's, arising from lymphocytes excluding Reed-Sternberg cells.
• Common aetiological factors include chromosomal translocation t(14;18), infections such as EBV, HIV, and environmental factors like benzene exposure.
• Categorized into T-cell lymphoma (15%) and B-cell lymphoma (85%), along with NK-killer lymphomas.
• Symptoms typically include painless and non-contagious lymphadenopathy, which can be categorized as high grade (fast-growing) or low grade (slow-growing) in cervical, axillary, or inguinal areas.
• B symptoms also present: fever, weight loss, night sweats, along with possible hepatosplenomegaly and cytopenia (reduced cell counts).

Hodgkin's Lymphoma

• Originates from lymphocytes; characterized by the presence of Reed-Sternberg (RS) cells, a type of B lymphocyte.
• Potential causes include Epstein-Barr virus (EBV) infection (45%), immunodeficiencies (organ transplant, HIV, immunosuppressive treatments), and autoimmune diseases (such as systemic lupus erythematosus, rheumatoid arthritis, Sjogren's syndrome, celiac disease).

Classifications

• Classical Hodgkin's Lymphoma (90% prevalence):
  • Most common subtype: Nodular sclerosis.
  • Other subtypes: Mixed cellularity, lymphocyte depleted (worst prognosis), lymphocyte-rich (best prognosis).
• Rare subtype: Nodular Lymphocyte Predominant Hodgkin's Lymphoma (NLPHL) (10% prevalence).

Signs and Symptoms

• Painless lymphadenopathy typically in cervical, axillary, and inguinal regions. Malignant spread possible.
• May present with mediastinal mass leading to chest pain, cough, and shortness of breath, also causing fatigue and weakness.
• B symptoms: Fever, weight loss, night sweats.
• Rare symptoms include Pel-Ebstein fever (fluctuating fever episodes lasting weeks) and alcohol-induced pain in lymph nodes following alcohol consumption.
• Pruritus may also occur.

Diagnosis

• Complete Blood Count (CBC): May show elevated/decreased white blood cells, anemia, and 20% eosinophilia.
• Histological findings: Identification of Reed-Sternberg cells which require lymph node excision; fine needle biopsy may be inadequate. RS cells typically are large with bilobed nuclei and are CD15/CD30-positive on immunohistology.
• Imaging techniques:
  • X-ray can reveal masses and enlarged lymph nodes in various regions.
  • Bone scintigraphy or PET-CT used for detecting bone infiltration and staging progression of the disease.

Treatment

• Common treatment regimen involves chemotherapy and radiotherapy, specifically the ABVD protocol (Adriamycin, bleomycin, vinblastine, dacarbazine).
• Generally favorable prognosis with a 5-year survival rate of approximately 80-90%, exceeding 90% in pediatric cases.

Non-Hodgkin's Lymphoma

• Involves cancers from all other types of lymphocytes excluding Reed-Sternberg cells.

Aetiology

• Frequently associated with chromosomal translocation t(14;18).
• Linked to infections (EBV, HIV, HTLV-1, HCV, Helicobacter pylori), autoimmune diseases, immunodeficiencies, and environmental factors (like benzene and radiation exposure).

Classifications

• Distinctly categorized into T-Cell Lymphoma (15% of cases) and B-Cell Lymphoma (85%).
• Includes NK-Killer Lymphoma as another subtype.

Signs and Symptoms

• Presents as painless lymphadenopathy, which can either be high grade (fast-growing) or low grade (slow-growing) occurring in cervical, axillary, or inguinal lymph nodes.
• Typical B symptoms include fever, weight loss, night sweats, along with hepatosplenomegaly and possible cytopenia, characterized by decreased cell counts.

Hodgkin's Lymphoma

• Characterized by better prognosis compared to non-Hodgkin's lymphoma.
• Cancer develops from lymphocytes, specifically multinucleated Reed-Sternberg cells (RSC), a variant of B lymphocytes.
• Aetiology includes:
  • Epstein-Barr virus (EBV) in 45% of cases.
  • Immunodeficiencies linked to organ transplants, HIV, immunosuppressants, and chemotherapy.
  • Autoimmune diseases such as systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), Sjogren's syndrome, and celiac disease.
• Classifications are divided into:
  • Classical (90% of cases), which includes:
    • Nodular sclerosis (most prevalent).
    • Mixed cellularity.
    • Lymphocyte depleted (associated with poorer prognosis).
    • Lymphocyte-rich (better prognosis).
  • Rare subtypes (10% of cases) like Nodular Lymphocyte Predominant HL (NLPHL) that allow for easier tailored treatment.
• Key signs and symptoms:
  • Painless lymphadenopathy primarily in cervical, axillary, and inguinal regions, indicative of malignant spread.
  • Possible mediastinal mass leading to chest pain, cough, and shortness of breath.
  • Causes of fatigue and weakness.
  • Development of B symptoms: fever, weight loss, and night sweats.
  • Rare symptoms include Pel-Ebstein fever (fluctuating fever over weeks) and alcohol-induced pain in lymph nodes after drinking.
  • Pruritus (itchiness) may occur.
• Diagnosis typically involves:
  • Complete blood count revealing elevated or decreased white blood cell count, anemia, or eosinophilia (up to 20%).
  • Histological examination for RSC, requiring lymph node excision for adequate sample size since fine needle biopsy is insufficient. RSC appear large, bilobed, and are CD15/CD30-positive.
  • Imaging techniques like X-rays to identify masses and enlarged lymph nodes, with bone scintigraphy or PET-CT to assess bone infiltration and disease progression.
• Treatment commonly includes a combination of chemotherapy and radiotherapy, specifically the ABVD regimen (Adriamycin, bleomycin, vinblastine, dacarbazine).
• Prognosis is generally good with a 5-year survival rate around 80-90%, exceeding 90% in pediatric cases.

Non-Hodgkin's Lymphoma

• Exhibits worse prognosis compared to Hodgkin's lymphoma.
• Cancer arises from various forms of lymphocytes excluding Reed-Sternberg cells.
• Aetiology factors include:
  • Chromosomal translocation t(14;18), most frequently associated with the disease.
  • Viral infections like EBV, HIV, HTLV-1, HCV, and Helicobacter pylori.
  • Autoimmune diseases including SLE, RA, Sjogren's syndrome, and celiac disease.
  • Immunodeficiencies and environmental risk factors, including benzene exposure and radiation.
• Classifications encompass:
  • T-cell lymphoma (15%).
  • B-cell lymphoma (85%).
  • NK-Killer lymphoma (natural killer cell lymphoma).
• Symptoms include:
  • Pain, potentially reflecting tumor growth or lymphadenopathy in affected regions.