Lymphoma Module Task 1. Describe Histologic Classification of Hodgkin's Disease !

Name:PRIIYA ASHIWINI A/P KRISHNAN
NIM:0910714013
KBI 09’
LYMPHOMA
MODULE TASK
1. Describe histologic classification of Hodgkin’s disease !
Histologic classification of Hodgkin disease

1. Lymphocyte-predominat HD is usually characterized by limited disease (stage I or II) in the neck.
2. Nodular sclerosis HD, is the most common subtypeand frequntly associated with mediastinal mass
ans hilar lymphnadenopathy in addition to disease in the neck.
3. Mixed cellularity HD
Lymphocyte-depleted HD. The mixed cellularity HD and lymphocyte-depleted HD are more common
in constitusional symptom and advace disease
2. Describe in brief The Ann Arbor Staging System for Hodgkin’s Disease !
Table 1. The Ann Arbor Staging System for Hodgkin’s Disease
Stage Definition
I Involvement of a single lymph node region or lymphoid structure (e.g., spleen,
thymus, Waldeyer's ring)
II Involvement of two or more lymph node regions on the same side of the
diaphragm (the mediastinum is a single site; hilar lymph nodes should be
considered “lateralized” and, when involved on both sides, constitute stage II
disease)
III Involvement of lymph node regions or lymphoid structures on both sides of the
diaphragm
III1 Subdiaphragmatic involvement limited to spleen, splenic hilar nodes, celiac
nodes, or portal nodes
III2 Subdiaphragmatic involvement includes paraaortic, iliac, or mesenteric nodes
plus structures in III1
IV Involvement of extranodal site(s) beyond that designated as “E”. More than one
extranodal deposit at any location. Any involvement of liver or bone marrow
A No symptoms
B Unexplained weight loss of >10% of the body weight during the 6 months before
staging investigation
Unexplained, persistent, or recurrent fever with temperatures >38°C during the
previous month
Recurrent drenching night sweats during the previous month
E Localized, solitary involvement of extralymphatic tissue, excluding liver and
bone marrow
3. Describe clinical features and laboratory findings to diagnose Hodgkin’s disease !
History
Clinical history features of Hodgkin disease (Hodgkin's lymphoma)
 Asymptomatic lymphadenopathy may be present (above the diaphragm in 80% of patients).
 Constitutional symptoms (eg, unexplained weight loss, fever, night sweats) are present in 40% of
patients. Collectively, these are known as "B symptoms."
 Intermittent fever is observed in approximately 35% of cases. Infrequently, the classic Pel-
Ebstein fever is observed (high fever for 1-2 wk followed by an afebrile period of 1-2 wk).
 Chest pain, cough, shortness of breath, or a combination of these things may be present due to
a large mediastinal mass or lung involvement. Rarely, hemoptysis is observed.
 Patients may present with pruritus.
 Alcohol-induced pain at sites of nodal disease is specific for Hodgkin disease (Hodgkin's
lymphoma) and occurs in less than 10% of patients.
 Back or bone pain occurs rarely.
Physical
Physical examination findings in Hodgkin disease (Hodgkin's lymphoma)
 Palpable painless lymphadenopathy occurs in the cervical area (60-80%), axilla (6-20%), and,
less commonly, in the inguinal area (6-20%). It is described as rubbery adenopathy.
 Involvement of the Waldeyer ring or occipital or epitrochlear areas is infrequently observed.
 Splenomegaly may be present.
 Patients may have hepatomegaly.
 Superior vena cava syndrome resulting from massive mediastinal lymphadenopathy can also be
seen.
 Central nervous system (CNS) symptoms or signs may be due to paraneoplastic syndromes,
including cerebellar degeneration, neuropathy, Guillain-Barre syndrome, or multifocal
leukoencephalopathy.
4. Describe in brief the treatment of Hodgkin’s disease !
The list of treatments mentioned in various sources for Hodgkin's Disease includes the following list. Always seek
professional medical advice about any treatment or change in treatment plans.
 Radiation therapy
o External radiation - usually the type of radiation used
o Internal radiation
 Chemotherapy
 Surgery - note that typical tumor removal surgery is not possible with lymphomas because the "tumor" is not
solid, but is dispersed widely through the body. However, some types of "surgery" such as bone marrow transplants
are being investigated.
5. Describe etiology of non-Hodgkin’s lymphoma !

Etiology
-A number of environmental factors have been implicated in the occurrence of non-Hodgkin's lymphoma,
including infectious agents, chemical exposures, and medical treatments. Several studies have
demonstrated an association between exposure to agricultural chemicals and an increased incidence in
non-Hodgkin's lymphoma. However, the infectious etiology of non-Hodgkin's lymphoma is the area where
evidence has been expanding most rapidly in recent years.. HTLV-I infects T cells and leads directly to
the development of adult T cell lymphoma (ATL) in a small percentage of infected patients. The
cumulative lifetime risk of developing lymphoma in an infected patient is 2.5%. The virus is transmitted by
infected lymphocytes ingested by nursing babies of infected mothers, blood-borne transmission, or
sexually. The median age of patients with ATL is about 56 years, emphasizing the long latency.
6. Describe clinical features and laboratory findings to diagnose non-Hodgkin’s lymphoma !
Clinical Features
-most patients with NHL, present with peripheral adenopathy. This is especially true in the indolent
lymphomas, and most patients with indolent lymphomas also have bone marrow involvement. Patients
with more aggressive B-cells lymphomas ( diffuse large cell and small noncleaved) present with large
abdominal or mediastinal masses. Patients with lymphoblastic lymphoma (T-cell lymphoma) often
persent with a mediastinal mass and central nervous system (CNS) or bone marrow involvemaent.
Waldeyer’s ring is involve in 15% to 30% of patients with NHL, and the incidence of gastrointestinal tract
involvement is higher in this group of patients.
Laboratory Findings
-The most important laboratory paramater, especially in aggressive NHL, is the lactat dehydrogenase
(LDH) level. Numerous studies have found LDH to be an important predictor of outcome in NHL. β 2-
microglobulin levels also may be an important predictor of outcome, although different patterns of β 2-
microglobulin levels have been described by Rodriquez et al. The serum uric acid level may be elevated
when tumor burden is high.
-Elevations in serum creatinine may reflect either direct renal involvementby lymphoma or urethral
obstruction.
7. Describe in brief The International Prognostic Index for non-Hodgkin’s lymphoma !
The prognosis of patients with NHL is best assigned using the International Prognostic Index (IPI) (Table
2) . This is a powerful predictor of outcome in all subtypes of NHL.. Patients are assigned an IPI score
based on the presence or absence of five adverse prognostic factors and may have none or all five of
these adverse prognostic factors.
Table 2. International Prognostic Index for NHL
Five clinical risk factors :

1. Age  60 years
2. Serum lactate dehydrogenase levels elevated
3. Performance status  2 (ECOG) or  70 (Karnofsky)
4. Ann Arbor stage III or IV
5. More than 1 site of extranodal involvement
Patients are assigned a number for each risk factor they have
Patients are grouped differently based upon the type of lymphoma
For diffuse large B cell lymphoma :
0, 1 factor = low risk 35% of cases; 5 years survival 73%
2 factors = low – intermediate risk 27% of cases; 5 years survival 51%
3 factors = high – intermediate risk 22% of cases; 5 years survival 43%
4, 5 factors = high risk 16% of cases; 5 years survival 26%

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Name:PRIIYA ASHIWINI A/P KRISHNAN

Histologic classification of Hodgkin disease

Table 1. The Ann Arbor Staging System for Hodgkin’s Disease

4. Describe in brief the treatment of Hodgkin’s disease !

5. Describe etiology of non-Hodgkin’s lymphoma !

6. Describe clinical features and laboratory findings to diagnose non-Hodgkin’s lymphoma !

7. Describe in brief The International Prognostic Index for non-Hodgkin’s lymphoma !

Table 2. International Prognostic Index for NHL

Five clinical risk factors :

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