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33 Cards in this Set

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Age-distribution of Hodgkin's Lymphoma.
Bimodal distribution:
-Major peak 15-34
-Lesser peak after 55
Hodgkin's Lymphoma:
Histologic Features
CD Markers
Cell Origin (location)
-Multi-nucleate REed-Sternberg Cells (Owl's Eyes)
-Background of normal inflammatory cells (non-malignant)

Note: only 1-5% of total tumor mass are R-S cells

CD15+ and CD30+ = Hodgkin's

B-cells originate at germinal center or post-germinal center (even though fail to express Ig genes!)
What is a crippling Ig gene rearrangement? When is it acquired?
Acquired during somatic hypermutation and for some reason doesn't result in apoptosis.

Cells are allowed to escape cell death and acquire additional mutations-->malignant R-S cell
What causes transformation of R-S cells?
This is hypothetical:
EBV (EBV DNA localized in R-S cells)

There's more Hodkin's in HIV
Hodgkin's Lymphoma:
Presentation
Cervical LN enlargement
Mediastinal involvement by CT
Involvement of spleen
Hodgkin's vs Non-Hodgkin's Lymphoma:
Spread
HL: initially localized at single peripheral LN region; subsequent progression by contiguity within lymphatic system. Contiguous spread!

NHL: Diffuse spread initially
Hodgkin's Lymphoma:
Ann Arbor Staging (I-IV)
Subscripts (E, S)
I: Single LN group involved

II: Involvement of 2 or more LN groups on same side of diaphragm

III: involvement of LN regions on both sides of diaphragm

IV: Outside LN areas (BM, liver)

Subscripts:
S = splenic involement
E = extranodal extension
What is bulky disease in HL?
Widening of mediastinum by >1/3 of chest diameter
A vs B Symptoms
A: absence of constitutional symptoms
B: presence of constitutional symptoms (Fever >38 degrees C, Weight Loss >10% over last 6 mos, Night Sweats)

Constitutional syx present with widespread dz.
What's the Pel-Epstein fever?
Cyclical fever (on and off); pathognomonic of HL
Patient presents with bilateral cervical and axillary LAD.

Complains of malaise, night sweats, loss of weight over last 3 months.

What's his Ann Arbor stage?
Stage IIB (B bc has B syx)
Classical HD vs Non-Classical HD: General
Classical:
RS cells positive for CD15 and CD30

Non-classical:
RS cells ARE CD15-, CD30-, CD20+
Lacunar cells are indicative of ________.
Nodular Sclerosis subtype of Classical HD

Lacunar cells are RS cells (owl eyes) that undergo shrinkage when cells are fixed. All are CD15+, CD30+.
What are popcorn cells?
Popcorn cells are lymphocytic histiocyte cells (LH) present in non-classical HD.

Don't need to recognize for exam.
What is the only subtype of non-classical HD?
lymphocyte predominant
What is the most common subtype of HD?
Age distribution?
Presentation?
Nodular Sclerosis

Predominates in young adults

Presents with cervical and anterior mediastinal involvement in young adult FEMALES>
Nodular Sclerosis:
Histologic Features
Nodular (collagen bands)
Lacunar R-S cells
The link with EBV is strongest in this subtype of HD.
Mixed Cellularity HD
Mixed Cellularity HD:
Histologic Features
R-S Cells surrounded by a mix of cells (ephils, lymphocytes, histiocytes)
Lymphocyte-Rich HD:
Histologic Features
R-S cells surrounded by small lymphocytes
Lymphocyte-Predominance HD:
Histologic Features
NOT A CLASSICAL HD

Lymphocyte predominance with nodularity (subtle)

No R-S cells

Popcorn cells (L&H cells) with CD15-, CD30-, CD20+
HD:
Treatment
ABVD:
Adriamycin - cardiac tox
Bleomycin - pulm fibrosis
Vinblastine - MT agent
Dacarbazine - alkylating

Note:
Choice depends on stage of dz
XRT alone may be adequate for early stage favorable HD, but combined modality tx may be more effective

Also, higher doses of XRT are curative, but increase incidence of solid tumors in irradiation field (and inc CAD)
What is the most important prognostic variable for HL?
Staging!

Early stage cure rates of 90%
HD:
Complications of treatment (early vs late mortality)
Non-malignant complications
Early mortality due to HD recurrence

After 15 years, almost all deaths due to secondary malignancy, CV, pulm dz (related to radiation, alkylating agents)

Non-malig:
Sterility (MOPP)
Infectious complications
Cardiac/pulmonary complication of mediastinal XRT and chemotx