HODGKINS LYMPHOMA. Anemia,bleeding tendency. Hepatosplenomegaly.
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Transcript of HODGKINS LYMPHOMA. Anemia,bleeding tendency. Hepatosplenomegaly.
HODGKIN’S LYMPHOMA
Anemia ,bleeding tendency.Hepatosplenomegaly .
DIAGNOSIS
• The investigation are a. Chest x rayb. USG of spleen ,liver and abdominal lymphnode.c. CT scand. Liver function teste. Bone marrow ,spleen and liver biopsy.f. Staging laparotomy. Hb estimation low Total count of WBC may increase due to over spill of the lymphoma cells into
peripheral blood .Serum uric acid increased Complete or partial destruction of the nodal architecture (reticulin stain)Presence of abnormal reticulum cells.Presence of Sternberg Reed giant cells.Character of Sternberg Reed :Large cell ,paired nuclei (mirror image or owl eye),cytoplasm eosinophilic
Staging of Hodgkin’s lymphoma (Ann Arbor classification)Stage I : involvement of single lymphnode
region or extra lymphatic site.Stage II : involvement of 2 or more
lymphnodes region or an extralymphatic site and lymphnode region on the same side of (above or below )the diaphragm.
Stage III : involvement of lymphnode regions on both sides of the diaphragm with or without localized extralymphatic involvement or involvement of the brain or spleen.
Stage IV: diffuse involvement of one or more extralymphatic tissue . E.g –liver or bone marrow.
Each stage is subdivided into A and B categories:
A—no systemic symptoms B-- with B symptoms (unexplained fever
above 38 C ,heavy night sweats ,unexplained weight loss of more than 10% of bd wt. in previous 6 months.
Treatment 1. Radiotherapy 2. Chemotherapy –ChlVPP regimeni. Chlorambucil 6 mg/m sq. Days 1 to 14
orally.ii. Vinblastine 6 mg/ m sq. Days 1 and 8 i.viii. Procarbazine 100 mg/m sq. Days 1 to 14
orally.iv. Prednisolone 40 mg/m sq. Days 1 to 14
orally
3. Combined modality treatment : chemotherapy followed by radiotherapy to original sites of bulk disease which have been shrunk by chemotherapy
NON-HODGKIN’S LYMPHOMA
THREE HISTOLOGIC SUBTYPES:
St. Judes staging system for non Hodgkin’s lymphomaStage I- Single nodal or extra nodal site
excluding mediastinum and abdomen.Stage II- single extranodal site with regional node
involvement. -two or more nodal areas on the same side of
the diaphragm. -two single (extranodal) tumors with or without
regional node involvement on the same side of the diaphragm.
-primary git tumor usually in the ileocecal areas with or without involvement of associated mesenteric nodes (resectable ).
Stage III-two extra nodal sites on the opposite of the diaphragm.
-two or more nodal areas above and below the diaphragm.
-primary intra thoracic tumors(mediatinal ,pleural,thymic)
-extensive intrabdominal disease -paraspinal or epidural tumors.Stage IV –any of the above with bone marrow
or CNS involvement.
DIAGNOSIS • Biopsy
Treatment 1.Low grade lymphoma: T cell typeStage I and II A –involved field radiotherapy.Stage IIB ,III, IV : chemotherapy single agent or
combination whole body irradiation .Drug commonly used Chlorambucil 20mg/m sq. orally daily.
2. High grade :B cell typeStage I :involved field radiotherapy.Stage II,III and IV: intensive combination
chemotherapy to the limit of patient tolerance Combined chemotherapy –cyclophosphamide ,adriamycin,vincristine (oncovin) and prednisolone (CHOP).
Hodgkin’s Non Hodgkin’s•Peak at elderly and young age •Extremes of ages
•Onset is gradual •Variable
•Lymphadenopathy :i.More often localized to a single axial group of nodes (cervical ,mediastinal)ii.Orderly spread by contiguity iii.Mesenteric nodes and waldayer’s ring are rarely involved iv.Extranodal involvement uncommon
Lymphadenopathy :i.More frequent involvement of multiple peripheral nodes.ii.Noncontiguous spread.iii.Waldayer’s ring and mesenteric nodes commonly involved .iv.Extranodal involvement common .
•Systemic feature such as puritis is most common.
•Systemic features are uncommon.
•Reed sternberg giant cell are present in lymphnode biopsy
•It is absent