Asymptomatic lymphadenopathy

Mediastinal mass

Systemic symptoms

Fever ,  Pruritus

Other nonspecific symptoms and paraneoplastic syndromes

Intra-abdominal disease

Cholestatic liver disease

Nephrotic syndrome

Hodgkin's disease

Clinical presentation

Alcohol-induced pain

Skin lesions , Neurologic syndromes

HODGKIN”s diseaseHODGKIN”s disease

    Nodular sclerosis HD

    Mixed cellularity HD

    Lymphocyte depletion HD

    Lymphocyte-rich classical HD

    Nodular lymphocyte predominant HD

 Stage I — Involvement of single lymph node region (I) or of single extralymphatic organ or site (Ie)

 

Stage II — Involvement of two or more lymph node regions on the same side of the diaphragm alone (II) or with involvement of limited, contiguous extralymphatic organ or tissue (IIe)

 Stage III — Involvement of lymph node regions on both sides of the diaphragm (III) which may include the spleen (IIIs) or limited, contiguous extralymphatic organ or site (IIIe) or both (IIIes)

 Stage IV — Diffuse or disseminated foci of involvement of one or more extralymphatic organs or tissues, with or without associated lymphatic involvement

Staging in hodgkin”s LymphomaStaging in hodgkin”s Lymphoma

•  

B symptoms•

** Clinical stage IIB to IVB  Bulky disease  Anemia Leukopenia Thrombocytopenia

Poor prognose sign & symptome in HDPoor prognose sign & symptome in HD

International prognostic scoreInternational prognostic score : International Prognostic Factor Project on Advanced Hodgkin's Disease based upon the total number of seven potential unfavorable features at diagnosis:

1-Serum albumin less than 4 g/dL (40 g/L), 2-Hemoglobin less than 10.5 g/dL (105 g/L), 3-Male gender, 4-Age over 45 years, 5-Stage IV, 6-White blood cell count 15,000/microL, 7-Lymphocyte count less than 600/microL and/or less than 8 percent of the white blood cell count . This analysis showed a spread in the event-free survival at five years, as follows:

No factors --— 84 % ( 7 % of patients)

 One factor —-- 77 % (22 % of patients)

 Two factors — 67 % (29 % of patients) 

Three factors — 60 % (23 % of patients)

 Four factors — 51 % (12 % of patients)

 Five or more factors --42% (7 % of patients)

Criteria for B symptomsCriteria for B symptoms :

B symptoms generally correlate with advanced stage and bulk disease. Specific B symptoms are defined as follows:

   1- Unexplained weight loss of more than 10 percent of body weight during the six months before initial staging investigation

   2-  Unexplained persistent or recurrent fever with temperatures above 38؛C during the previous month

3- Recurrent drenching night sweats during the previous month.

1- Socioeconomic status and environmental risk factors1- Socioeconomic status and environmental risk factors

2- Infectious agents2- Infectious agents

3- Clustering3- Clustering

4- Genetic factors4- Genetic factors

5- ROLE OF EPSTEIN-BARR VIRUS5- ROLE OF EPSTEIN-BARR VIRUS

6- HD and immunosuppression6- HD and immunosuppression

Incedence of HDIncedence of HD

HISTORY AND PHYSICAL EXAMINATION

Initial evaluation and diagnosis of Hodgkin's diseaseInitial evaluation and diagnosis of Hodgkin's disease

TISSUE BIOPSY

Bone marrow biopsy

LABORATORY STUDIES

IMAGING STUDIES: chest, abdomen, liver, spleen, bone.

Gastrointestinal tract

Central nervous system

CLASSICAL HODGKIN'S LYMPHOMACLASSICAL HODGKIN'S LYMPHOMA

Nodular sclerosis Hodgkin's lymphoma

Mixed cellularity Hodgkin's lymphoma

Lymphocyte depletion Hodgkin's lymphoma

Lymphocyte-rich classical Hodgkin's lymphoma

Immunophenotype in HD :

The immunophenotype is an important part of the definition of NLPHL.

The atypical cells are CD45+ , express B - cell associated antigens ( CD19 , CD20 , CD22 , CD79a ) , and EMA but lack CD15 and CD30.

HODGKIN”s diseaseHODGKIN”s disease

    Nodular sclerosis HD

    Mixed cellularity HD

    Lymphocyte depletion HD

    Lymphocyte-rich classical HD

    Nodular lymphocyte predominant HD

.

Of NHL WHO classification

Indolent — survival of the untreated disease measured in years

    Aggressive — survival of the untreated disease measured in months

    Highly aggressive — survival of the untreated disease measured in weeks.

.

Of NHL WHO classification

Indolent — survival of the untreated disease measured in years

    Aggressive — survival of the untreated disease measured in months

    Highly aggressive — survival of the untreated disease measured in weeks.

.

Of NHL WHO classification