Hodgkin Lymphoma
Hodgkin (disease) lymphoma has been known as a disease that affects lymphatic tissue since Thomas Hodgkin described it in 1832. Hodgkin lymphoma has continued to receive special recognition by the World Health Organization, which influences disease classification throughout the world. The disease was called Hodgkin's disease for about 170 years and was officially changed to Hodgkin lymphoma when sufficient evidence accrued that the cancer originated in a lymphocyte.
Hodgkin lymphoma is distinguished from other types of lymphoma by the presence of one characteristic type of cell, known as the Reed-Sternberg cell (named for the scientists who discovered it). Although they are found within the lymph nodes, Reed-Sternberg cells may not be lymphocytes.
Hodgkin lymphoma has other characteristic features that distinguish it from all other cancers of the lymph system. One of its unique features is its pattern of spread. Hodgkin lymphoma usually begins in the lymph nodes in one region of the body. As the disease progresses, it tends to spread in a fairly predictable manner, moving from one part of the lymph system to the next. Hodgkin lymphoma then moves into organs including the lungs, liver, bone and bone marrow.
There are four stages of Hodgkin lymphoma, based on the pattern of spread of the disease. Stage I represents local early-stage disease, while Stage IV means that the disease has spread to various organs distant from the original site of the disease. The histology, or pathologic interpretation under the microscope, may be nodular sclerosis, mixed cellularity, lymphocyte predominant or lymphocyte depleted. Because of the overall success of therapy, these subtypes are generally not important to the prognosis of Hodgkin lymphoma.
Symptoms and Signs
The most common early sign of Hodgkin lymphoma is a painless swelling of the lymph nodes in the neck, upper chest, interior of the chest, armpit, abdomen or groin. Involvement of lymph nodes in other locations may occur less frequently. Other symptoms include fever, sweating (especially at night), weight loss and itching. Patients may experience pain in the lymph nodes after drinking alcohol, an uncommon but distinctive finding in Hodgkin lymphoma. The spleen may be enlarged.
Approach to Diagnosis
The diagnosis of Hodgkin lymphoma requires the biopsy of an involved lymph node or other tumor site. A pathologist prepares a slide from the biopsy specimen and evaluates the cells using a microscope. Several patterns of lymph node changes are characteristic and diagnostic of Hodgkin lymphoma. The changes can be categorized into four patterns: lymphocyte predominance, nodular sclerosis, mixed cellularity or lymphocyte depletion types of Hodgkin lymphoma.
In some cases, the use of immunophenotyping can help distinguish Hodgkin lymphoma from the other types of lymphomas or other lymph node reactions that are not cancerous. The pathologist also uses the presence of special cells to confirm the diagnosis. These cells are called Reed-Sternberg cells in recognition of the pathologists who first described them. Other related cells are referred to as Hodgkin cells.
The pathological diagnosis of Hodgkin lymphoma can be difficult. Diagnosis often requires an experienced pathologist to analyze the biopsy slides.
Staging
In addition to physical examination, the physician can use imaging procedures to determine the extent of the disease. These tests help the physician to evaluate: 1) the location and distribution of lymph node enlargement; 2) whether organs other than lymph nodes are involved; and 3) whether there are very large masses of tumor in one site or another.
In most cases, these procedures will include computed tomography (CT) or magnetic resonance (MR) imaging of the abdomen. Today, it is unusual to require a procedure referred to as a staging laparotomy, which is a surgical procedure to inspect and biopsy the lymph nodes in the abdomen and the liver and remove the spleen. The information gathered from these studies permits the patient to be assigned to a "stage" of disease.
Stage I represents apparent involvement of a single lymph node region or a single organ, such as bone.
Stage II indicates the involvement of two or three lymph node regions that are close to each other, for example, all in the neck and chest, or all in the abdomen.
Stage III represents the involvement of several lymph node regions in the neck, chest and abdomen.
Stage IV means there is widespread involvement of lymph nodes and other organs, such as lungs, liver and bone.
The four stages of Hodgkin lymphoma can be divided into "A" and "B" categories. The "A" category indicates the absence of fever, exaggerated sweating and weight loss. Patients who experience these symptoms belong to the "B" category. For example, Stage IIB indicates that the patient has two nearby lymph node sites involved in the disease and has fever, exaggerated sweating, or weight loss. Examples of two nearby sites include enlarged lymph nodes in the neck and near the collar bone - or in the neck and the armpit.
Blood cell counts, bone marrow examination and performance of blood tests that can detect liver involvement and the severity of the disease also are useful in assessing the approach to treatment.
Hodgkin lymphoma is distinguished from other types of lymphoma by the presence of one characteristic type of cell, known as the Reed-Sternberg cell (named for the scientists who discovered it). Although they are found within the lymph nodes, Reed-Sternberg cells may not be lymphocytes.
Hodgkin lymphoma has other characteristic features that distinguish it from all other cancers of the lymph system. One of its unique features is its pattern of spread. Hodgkin lymphoma usually begins in the lymph nodes in one region of the body. As the disease progresses, it tends to spread in a fairly predictable manner, moving from one part of the lymph system to the next. Hodgkin lymphoma then moves into organs including the lungs, liver, bone and bone marrow.
There are four stages of Hodgkin lymphoma, based on the pattern of spread of the disease. Stage I represents local early-stage disease, while Stage IV means that the disease has spread to various organs distant from the original site of the disease. The histology, or pathologic interpretation under the microscope, may be nodular sclerosis, mixed cellularity, lymphocyte predominant or lymphocyte depleted. Because of the overall success of therapy, these subtypes are generally not important to the prognosis of Hodgkin lymphoma.
Symptoms and Signs
The most common early sign of Hodgkin lymphoma is a painless swelling of the lymph nodes in the neck, upper chest, interior of the chest, armpit, abdomen or groin. Involvement of lymph nodes in other locations may occur less frequently. Other symptoms include fever, sweating (especially at night), weight loss and itching. Patients may experience pain in the lymph nodes after drinking alcohol, an uncommon but distinctive finding in Hodgkin lymphoma. The spleen may be enlarged.
Approach to Diagnosis
The diagnosis of Hodgkin lymphoma requires the biopsy of an involved lymph node or other tumor site. A pathologist prepares a slide from the biopsy specimen and evaluates the cells using a microscope. Several patterns of lymph node changes are characteristic and diagnostic of Hodgkin lymphoma. The changes can be categorized into four patterns: lymphocyte predominance, nodular sclerosis, mixed cellularity or lymphocyte depletion types of Hodgkin lymphoma.
In some cases, the use of immunophenotyping can help distinguish Hodgkin lymphoma from the other types of lymphomas or other lymph node reactions that are not cancerous. The pathologist also uses the presence of special cells to confirm the diagnosis. These cells are called Reed-Sternberg cells in recognition of the pathologists who first described them. Other related cells are referred to as Hodgkin cells.
The pathological diagnosis of Hodgkin lymphoma can be difficult. Diagnosis often requires an experienced pathologist to analyze the biopsy slides.
Staging
In addition to physical examination, the physician can use imaging procedures to determine the extent of the disease. These tests help the physician to evaluate: 1) the location and distribution of lymph node enlargement; 2) whether organs other than lymph nodes are involved; and 3) whether there are very large masses of tumor in one site or another.
In most cases, these procedures will include computed tomography (CT) or magnetic resonance (MR) imaging of the abdomen. Today, it is unusual to require a procedure referred to as a staging laparotomy, which is a surgical procedure to inspect and biopsy the lymph nodes in the abdomen and the liver and remove the spleen. The information gathered from these studies permits the patient to be assigned to a "stage" of disease.
Stage I represents apparent involvement of a single lymph node region or a single organ, such as bone.
Stage II indicates the involvement of two or three lymph node regions that are close to each other, for example, all in the neck and chest, or all in the abdomen.
Stage III represents the involvement of several lymph node regions in the neck, chest and abdomen.
Stage IV means there is widespread involvement of lymph nodes and other organs, such as lungs, liver and bone.
The four stages of Hodgkin lymphoma can be divided into "A" and "B" categories. The "A" category indicates the absence of fever, exaggerated sweating and weight loss. Patients who experience these symptoms belong to the "B" category. For example, Stage IIB indicates that the patient has two nearby lymph node sites involved in the disease and has fever, exaggerated sweating, or weight loss. Examples of two nearby sites include enlarged lymph nodes in the neck and near the collar bone - or in the neck and the armpit.
Blood cell counts, bone marrow examination and performance of blood tests that can detect liver involvement and the severity of the disease also are useful in assessing the approach to treatment.
posted by TM at 6:14 AM
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