MRCP revision battle 39.1: Hodgkin's Lymphoma
MRCP revision battle 39.2: Non-Hodgkin's lymphoma
MRCP revision battle 39.3: Systemic mastocytosis
MRCP revision battle 39.4: Thrombocytosis
MRCP revision battle 39.5: Haemophilia
MRCP revision battle 39.6: The spleen
MRCP revision battle 39.7: Autoimmune haemolytic anaemia
MRCP revision battle 39.1: Hodgkin's Lymphoma
Lymphomas are malignant proliferations of lymphocytes. These may accumulate in lymph nodes, in organs or in the peripheral blood.
Lymphomas are divided into 2 main types: Hodgkin's, which has characteristic Reed-Sternberg cells, and non-Hodgkin's, which do not have Reed-Sternberg cells.
The slide below (by Dr Ed Uthman) shows a Reed-Sternberg cell in the centre with its characteristic mirror-image nuclei:
Staging of Hodgkin's lymphoma is done by the Ann Arbor system:
- I = one lymph node group
- II = 2 areas on one side of the diaphragm
- III = both sides of the diaphragm
- IV = extra-nodal tissues (NB the spleen is counted as an 'honorary' node)
Each stage is subdivided into A or B:
- A = no B symptoms
- B = T>38c, night sweats or weight loss >10% in 6 months
Pel Ebstein fever = cyclical fever with long periods of normal temperature - is so rare some believe it to be mythical...
Pruritus or alcohol-induced pain are not B symptoms bit are useful indicators of relapse.
Poor prognostic factors are:
- B symptoms
- stage IV
- Hb <10.5
- lymphocyte count <8%
- male
Histological subtypes of Hodgkin's lymphoma are:
- nodular sclerosing = most common, good prognosis
- mixed cellularity - good prognosis
- lymphocytic predominant = best prognosis
- lymphocytic depleated = least common, worst prognosis
Bloods will show:
- neutrophilia
- anaemia
- thrombocytosis
- raised ESR
- raised LDH - a useful guide to the bulk of the disease
Treatment is with radiotherapy, chemotherapy (ABVD) or both.
Now on to non-Hodgkin's lymphoma...
