Monday, 1 November 2010

MRCP revision battle 39.1: Hodgkin's Lymphoma

Its the second day of haematology fun!  Lets dive straight in...

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...