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. It represents 40 percent of adult lymphoma. It is commoner in males than females, with the exception of the nodular sclerosing subtype. Remember roses for the female (Mnemonic: sclerosis = roses = female). It is more common in Caucasians.
It has a bimodal age distribution; the first peak is around 15 to 34 years of age and the second peak is in patients older than 50 years of age. Patients with Hodgkin's disease are usually younger than those with non-Hodgkin's. So Hodgkin's is a disease of the young! It usually starts in the cervical lymph nodes causing cervical lymphadenopathy, which is painless. HIV patients have a 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 associated 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—women and children are the typical patients. It's the most common subtype of classic Hodgkin's. Anterior mediastinal nodes are often involved. It has an excellent prognosis, the best prognosis of all of these nodular scleroses. It has the lacunar type Reed-Sternberg cell, which is a Reed-Sternberg cell variant. Lymphocyte-rich; it's rich, so it carries a very good prognosis. Lymphocyte-depleted, on the other hand, is depleted. So it has the poorest survival—bad prognosis—it's the most aggressive 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 a 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 going to be Hodgkin's. He takes a slice, puts 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 instead of just like a lab technician who just reads reports. Therefore, Hodgkin's—no, medicine is an art. Microscopic appearance; there are Reed-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-Epstein 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—if lymphadenopathy involves the 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 in 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. Reach cerebrum. So, a 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. 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. Perfection! Alice.