Transcription
Hey guys, how are things? I'm so excited today to continue our discussion on hematology. And today, it's time for Hodgkin's lymphoma.
As you know, Hematological malignancies are leukemias, lymphomas, or myeloma. Lymphoma is a solid tumor of the lymphatic system, or lymphoid tissue such as: lymph node, spleen, mucosa-associated lymphatic tissue, etc. Lymphoma is divided into Hodgkin's lymphoma, and non-Hodgkin's lymphoma. Hodgkin's is less common than non-Hodgkin's. Hodgkin's is a local disease, with Reed Sternberg cells.
So, imagine that the genie appeared to you and told you: "you have been cursed by a lymphoma"! Which one should you choose? Of course, you should choose Hodgkin's lymphoma, because it's less evil than non-Hodgkin's. Your chance of survival with Hodgkin's is better than that with non-Hodgkin's lymphoma.
Represents 40 percent of adult lymphoma. Commoner in males than females, with the exception of nodular sclerosing subtype. Remember roses for the female (Mnemonic: sclerosis = roses = female). More common in Caucasian. Has bimodal age distribution; the first peak is around 15 to 34 years of age and the second peak; to patients older than 50 years of age. Patients of Hodgkin's disease are usually younger than those of non-Hodgkin's. So Hodgkin's is a disease of the young!
Usually starts in the cervical lymph nodes causing cervical lymphadenopathy, which is painless. HIV patients have higher risk of Hodgkin's disease and Hodgkin's is associated with a defect in cell mediated immunity. Did you know that exposure to benzene can lead to Hodgkin's lymphoma? Exposure to benzene can lead to acute leukemia as well. Hodgkin's disease has a complication of causing acute lymphoblastic leukemia. Hodgkin's is associated with Epstein Barr virus. Hodgkin's is more common in patients with a history of mono because it makes perfect sense since infectious mononucleosis is with Epstein-Barr virus (EBV).
Contiguous spread is common in Hodgkin's lymphoma. Which means from this lymph node to this lymph node to the next lymph node to the next one node in the same local area. This is different from non-Hodgkin's lymphoma, where there is distant spread. There is lymphadenopathy in Hodgkin's, absolutely. It's localized and it's painless. Remember painful infection? Painless malignancy. Secondary amyloidosis; the serum amyloid A protein or SAA protein.
Hodgkin's can be treated using radiation, which will lead to non-Hodgkin's. So you're trying to treat Hodgkin's using radiation, but now you end up with non-Hodgkin's. Talking about misfortune!!!
The classification of Hodgkin's is nodular lymphocyte predominance or Classic Hodgkin's. Classic Hodgkin's is more common. Classic Hodgkin's has four subtypes: Nodular sclerosis is by far the most common; it's commoner in females (roses). Lymphocyte rich, mixed cellularity. Lymphocyte depleted: they're the worst subtype.
So let's talk more about these subtypes. You have nodular lymphocyte predominance? 5% of cases and carries good prognosis. Nodular sclerosis, the most common subtype. Females more than males (roses). Women and children are the typical patients. It's the most common subtype of the classic Hodgkin's. Anterior mediastinal nodes are often involved. It has an excellent prognosis, the best prognosis of all of these are the nodules. Chlorosis. It has the lacunar type Reed Sternberg, so which is a Reed Sternberg sole variant. Lymphocyte rich, it's rich. So it carries very good prognosis. Lymphocyte depleted on the other hand, it's depleted. So it has the poorest survival, bad prognosis. It's the most aggressive of one and thankfully, it's the least common. It's depleted. Okay. Mixed cellularity, the name has the answer. It has more than one cell. It has eosinophils, plasma cells, histiocytes, etc. A disease of the elderly. Abdominal lymph nodes and spleen are often involved. So remember nodular sclerosis commoner in females, good prognosis. Lymphocyte rich, very good prognosis. Lymphocyte depleted, very bad prognosis. Mixed cellularity, more than one cell.
There is a genetic component to Hodgkin's disease. Nuclear factor Kappa light chain. It is a transcription factor. It will undergo activation by Epstein-Barr virus or other factors. Now we turn the switch on. Genes that promote proliferation are now on, leading to proliferation, proliferation, proliferation, proliferation, which is cancer.
Now, let's turn our attention to lymphadenopathy in Hodgkin's disease. It's localized. It's painless. It starts in the cervical nodes. The supraclavicular and the anterior mediastinal are also common. If you do a biopsy to this lymph node, and we use a core needle biopsy. Never use fine needle aspiration. We need a core needle biopsy for lymphoma. Ungrown appearance. You'll have bulging fish flesh appearance, rubbery inconsistency. A good pathologist can feel the lymph node and tell, "This is very rubbery. I can tell it's gonna be Hodgkin's." It takes a slice, put it under the microscope, and wow! Here we have the Reed Sternberg cell and we confirm the diagnosis of Hodgkin's lymphoma. That's a good pathologist that uses all of his senses to diagnose the disease and instead of just like a lab technician, just reads rumors. All therefore Hodgkin's. No, medicine is an art.
Microscopic appearance, there is Sternberg cells, which are positive for CD15 and CD30. Here's a side note. Did you know causes of mediastinal masses are the famous forties? Thyroid mass, thymoma, teratoma, and terrible lymphoma. The terrible lymphoma is Hodgkin's. Which subtype? Nodular sclerosis, and usually the patient is a female. Lymphoma in the mediastinum only too short of breath and dry cough.
Clinically, we have lymphadenopathy. We have fever. The fever comes, the fever goes. The fever comes, the fever goes. Comes and goes in a cyclical manner. We call this Pel-Ebstein fever. Itching is common. Splenomegaly, but not massive. Contrast that with CML that had massive splenomegaly. Nephrotic syndrome is common, especially minimal change disease. Think about it, minimal change disease is a disease of the young. Hodgkin's disease, the disease of the young. They go together. Obstructive jaundice of lymphadenopathy involve that porta hepatis, which is the door of the liver. Skin erythema nodosum. CNS cerebellar degeneration. Autoimmune hemolytic anemia, yes, in Hodgkin's disease as well as CLL. Pain and lymph nodes on alcohol consumption is a very specific sign. It's not sensitive. It's not common, but it's very specific.
Epstein Barr virus can cause Hodgkin's disease as well as non-Hodgkin's lymphoma. It commonly causes non-Hodgkin's lymphoma even more than Hodgkin's. Cancer caused by EBV: nasopharyngeal carcinoma, Burkitt's lymphoma, Hodgkin's lymphoma, primary CNS lymphoma, post-organ transplant lymphoma. The evil Epstein Barr.
So today we have finished talking about Hodgkin's. In the next videos, we will talk about diagnosis and treatment. Reached cerebrum. So mnemonic about Hodgkin's case, not only one case but 10 cases or 10 questions on Hodgkin's, then a quick review. So I think you should subscribe to my channel. And subscription doesn't mean anything because YouTube wants you to hit that notification. If you really like the channel and like to get notifications. Facebook, Twitter, SoundCloud, Instagram. You can support this channel on Patreon and I will love you so much. Until next time, be safe, stay happy, and study hard. Medicos is perfection. Alice.