Hodgkin’s Disease (HL)

• HL spreads in an orderly fashion – from one LN to the next
  • NHL has widespread dissemination
• Presence of Reed-Sternberg cell – large, bi-nuceate, each nucleus has a nucleolus (owl eyes)

Epidemiology

• Incidence NHL>HL
• Bimodal age distribution – 15-35 and >50

Etiology

• Unknown
• HLA association
• Increased incidence in pts with EBV

Classification

Nodular lymphocyte predominance (NLP)

• Rare RS cells, predominant background/benign cells (lymphocytes)
• RS is of a specific type – popcorn cell
• MC in young males
• Presents as a single LN in cervical/supraclavicular/axillary area

Nodular sclerosis (70%)

• MC in US
• MC in young females
• Characteristic – involvement of mediastinum

Mixed cellularity

• Frequent RS cells
• MC in older age
• More aggressive than NLP and ND

Lymphocyte depletion

• Two variants
  • One with predominance of RS cells and rare background cells
  • One with diffuse fibrosis and rare RS/background cells
• Aggressive

Lymphocyte rich

• Presents as localised disease
• Predominance of benign cells and rare RS cells
• Indolent course, good prognosis

Clinical features

• Painless lymphadenopathy – MC in cervical LN
  • Spreads in contiguous fashion
• B symptoms – fever, night sweats, WL, fatigue
• SVC obstruction
• Cervical lymphadenopathy

Staging (see table)

Diagnosis

• FBC – can be normal
  • Anemia/lymphopenia associated with poor prognosis
• ↑ESR
• ↑LFTs – may reflect hepatic infiltration
• ↑LDH – poor prognosis
• CXR – mediastinal mass
• FNAC – for LN biopsy

Treatment

• Stage I-II – Radiation
• Stage III-IV – Combination chemotherapy
  • MOPP – Mechlorethamine  , oncovin (vincristine), prednisone, procarbazine
    • Successful but can cause AML due to alkylating agents (methclorethamine and procarbazine)
    • SE – infertility in men
  • ABVD – adriamycin (doxorubicin), bleomycin, vinblastine, dacarbazine (4-6 cycles)
  • Standford V – 12 cycles
• Chemo complication