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Hodgkin Disease: Section 4
Hodgkin Disease: Section 4
Section 4
Lymphomas
Lymphomas
• Lymphomas are a group of diseases caused by
malignant lymphocytes that accumulate in lymph nodes
and cause the characteristic clinical features of
lymphadenopathy.
• Occasionally, they may spill over into blood (leukaemic
phase) or infiltrate organs outside the lymphoid tissue.
• The major subdivision of lymphomas is into Hodgkin
lymphoma and non - Hodgkin lymphoma and this is
based on the histological presence of Reed – Sternberg
(RS) cells in Hodgkin lymphoma.
Hodgkin lymphoma
• The disease can present at any age but is rare
in children and has a peak incidence in young
adults.
• There is an almost 2 : 1 male predominance.
The following symptoms are common:
Clinical features of Hodgkin
lymphoma
1. lymphadenopathy:
• Most patients present with painless, non-tender, asymmetrical, firm,
discrete and rubbery enlargement of superficial lymph nodes .
• The cervical nodes are involved in 60 – 70% of patients, axillary
nodes in approximately 10 – 15% and inguinal nodes in 6 – 12%.
• In some cases the size of the nodes decreases and increases
spontaneously. Typically, the disease is single peripheral lymph node
region and its subsequent progression is by contiguity within the
lymphatic system. Retroperitoneal nodes are also often involved but
usually only diagnosed by computed tomography (CT) scan.
localized, initially to
Clinical features of Hodgkin
lymphoma
2. Modest splenomegaly
occurs during the course of the disease in 50% of patients.
The liver may also be enlarged because of liver involvement.
Risk Factors
Serum albumin (<4 g/dL [40 g/L])
Hemoglobin (<10.5 g/dL [105 g/L; 6.52 mmol/L])
Male gender
Stage IV disease
Age (≥45 years)
3
White blood cell (WBC) count (≥15,000 cells/mm [15 ×
9
10 /L])
3 9
Lymphocytopenia (<600 cells/mm [0.6 × 10 /L] or <8%
of WBC count)
The International Prognostic Factors Project Score for
Advanced Hodgkin Lymphoma