Updated: 12/27/2021

Hodgkin Lymphoma

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  • Snapshot
    • A 65-year-old man with mycosis fungoides presents with increased fatigue, low-grade fevers, and night sweats. Given his history, he is scared that "something is going on." His primary care physician does a thorough physical exam and finds several small, rubbery, mobile supraclavicular lymph nodes. They are nontender. A lymph node biopsy shows pathology of Reed-Sternberg cells.
  • Introduction
    • B-cell malignancy originating in lymphatic system
    • Commonly early stage when diagnosed
      • as opposed to non-Hodgkin lymphoma (NHL), where people are in later stage disease at diagnosis
    • Types of Hodgkin lymphoma
      • nodular sclerosing
        • most common
        • female predominance
      • mixed cellularity
      • lymphocyte-rich/predominant
        • especially in < 35-year-olds
      • lymphocyte-depleted
        • especially in > 60-year-olds
        • other systemic diseases
  • Epidemiology
    • Incidence
      • bimodal distribution
        • young adulthood
        • > 55 years
    • Demographics
      • male > female except for nodular sclerosing type
      • more common in Caucasians
    • Risk factors
      • infectious mononucleosis with EBV
      • immunosuppression
      • smoking
      • mycosis fungoides
  • ETIOLOGY
    • Pathogenesis
      • 50% of cases associated with EBV infection
      • Reed-Sternberg cells
        • CD15+
        • CD30+
  • Presentation
    • Symptoms
      • constitutional ("B") symptoms
        • fever
        • night sweats
        • weight loss
        • all caused by cytokines released from Reed-Sternberg cells
      • contiguous spread
      • persistent painless lymphadenopathy
    • Physical exam
      • nontender mass of localized, single group of nodes
        • rubbery
        • mobile
        • cervical
        • supraclavicular
        • axillary
      • potential SVC syndrome
      • potential erythema nodosum
  • studies
    • Imaging for staging
    • Lymph node biopsy
      • Reed-Sternberg cells
        • binucleate or bilobed, “owl-eyed” nuclei
      • mixed cellularity type
        • large inflammatory infiltrate with many eosinophils
      • nodular sclerosing type
        • diffuse band-like fibrosis with lacunar spaces
  • Differential Diagnosis
    • Non-Hodgkin lymphoma
    • AIDS-related lymphadenopathy
    • Infection
    • Breast cancer
    • Cat-scratch fever
  • Treatment
    • Based on staging
    • Localized disease or early stage
      • excisional biopsy
      • chemotherapy
      • radiation
    • Late stage disease or anyone with B symptoms
      • ABVD
        • Adriamycin (doxorubicin)
        • Bleomycin
        • Vinblastine
        • Dacarbazine
  • Complications
    • Tumor lysis syndrome
      • hypocalcemia (most common)
      • hyperkalemia
      • hyperphosphatemia
      • hyperuricemia
    • SVC syndrome
    • Minimal change disease
    • Paraneoplastic syndromes
      • calctriol secretion causes hypercalcemia
    • From treatment
      • risk of solid tumors (breast, thyroid, and lung)
      • risk of premature coronary artery disease
      • risk of infection
      • doxorubicin – cardiomyopathy
      • vincristine – neuropathy
      • bleomycin – lung fibrosis
  • Prognosis
    • > 80% with treatment
      • better than non-Hodgkin lymphoma
      • lymphocyte-predominant = best prognosis
      • lymphocyte-deplete = worst prognosis
      • higher lymphocyte:RS cell ratio = better prognosis
    • 5-30% chance of relapse
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(M2.ON.15.4622) A 31-year-old man presents to his primary care physician with fevers, chills, and night sweats. After a physical exam and a series of laboratory tests, the patient undergoes a lymph node biopsy (Image A). Three days later, while awaiting treatment, he presents to his physician complaining of generalized swelling and is found to have 4+ protein in his urine. Which of the following pathological findings is most likely to be found on renal biopsy in this patient?

QID: 107001
FIGURES:

Rapidly progresive glomerulonephritis

5%

(1/22)

Amyloidosis

5%

(1/22)

Membranoproliferative glomerulonephritis

9%

(2/22)

Focal segmental glomerulosclerosis

9%

(2/22)

Minimal change disease

68%

(15/22)

M 6 E

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