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Hodgkin's Lymphoma (Diagnosis (FBC: normochromic normocytic anaemia,…
Hodgkin's Lymphoma
Type of malignant proliferation of lymphocytes, characterised by Reed Sternberg cells
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Reed Sternberg cells
'Crippled' geminal centre B lymphocytes that are binucleate and can be seen under light microscopy 
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Only form a small amount of cells in the tumour; remaining cells are lymphocytes, granulocytes, fibroblasts and plasma cells. These inflammatory cell infiltrates indicate an immune response from the host against the malignant cells
EBV
There is a correlation between EBV and HL. Increased EBV antibodies at time of diagnosis and some have EBV DNA in the tissue
Types
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Nodular lymphocyte predominant HL - Reed Sternberg variant called the Popcorn cell (small cell, with a very lobulated nucleus, small nucleoli)
Clinical features
Painless, asymmetrical, firm,
rubbery lymphadenopathy.
Contagious spread
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Mediastinal involvement (10%) - pleural
effusions, superior vena cava obstruction
B symptoms: fever, weight loss, night sweats, fatigue
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Diagnosis
FBC: normochromic normocytic anaemia, neutrophilic (sometimes eosinophilia), thrombocytopenia in later stages, raised ESR and CRP
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CXR: mediastinal widening, mediastinal mass
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Staging
Anne Arbour classification
1) Single lymph node area
2) 2 or more lymph node area on one side of diaphragm
3) node involvement above and below diaphragm
4) involvement outside node areas (e.g. liver, bone marrow)
Management
Late stage (stage 3 and 4)
Chemotherapy (may add radiotherapy if bulky disease or palliative)
Autologous (own) stem cell transplant - young patients who fail induction chemo or early relapse
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Assess response to treatment with PET scan. Regular pulmonary function tests are needed in patients taking bleomycin
Long term effects
Radiotherapy - lung cancer, breast cancer
Alkylating agents - myelodysplasia, AML
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Non‐malignant complications include sterility, intestinal complications, coronary artery disease and pulmonary complications of the mediastinal radiation or bleomycin chemotherapy.