A topic from general surgery

2. There are about 800 lymph nodes in the body.
Approximately 300 lymph nodes lie in the neck.
The lymphatic of head and neck drain in cervical lymph
nodes .
 There are 7 levels of neck and most have sublevels
consisting specific group of nodes

3. 1.Level I: Submental and
submandibular
2.Level II: Upper jugular
3. Level III: Middle jugular
4. Level IV: Lower jugular
5. Level V: Posterior triangle
6. Level VI: Anterior /Central
compartment
7. Level VII: Superior mediastinal

5. Hodking’s lymphoma is a malignant tumor of
lymphoreticular system arising mostly in lymph nodes and
rarely in extra nodal sites ( liver,spleen,etc.)
It was named after Thomas Hodgkin who described it in
1832.
Dorothy Reed and Carl Sternberg first described the
malignant cells of Hodgkin lymphoma and called it Reed-
Sternberg cells.
It has bimodal age disturbution i.e children and middle
age people are mostly affected.
It is more common in males.

6. • It usually starts as painless
enlargement of lymph nodes in left
supraclavicular region.
• Spread occurs to other lymph
nodes in downstream lymphatic
drainage in a systematic fashion.
• Grossly lymph nodes are pink grey
and cut surface is homogeneous and
smooth.

7. • Microscopically, characteristic
Reed-sternberg cells are seen.
• These are gaint cells containing
two large nuclei that may
overlap showing pennies on a
plate appearance.
• In addition histiocytes, plasma
cells,neutrophils, eosinophils
and lymphocytes may be seen.
• “Cellular pleomorphism” is a
striking feature of Hodgkin’s
Lymphoma.

8. Certain viruses:
Epstein Barr virus(EBV)
Human immunodeficiency virus(HIV)
Weakened immune system
Inherited Conditions
Certain drugs used after organ transplant
Family history
Family members especially brother and sister of a person with Hodgkin lymphoma
May have an increased chance of developing this disease

9.  Painless progressive enlargement of cervical lymph nodes.
 Systemic Symptoms include:
1. Unexplained fever with night sweats. Sometimes fever is seen in cyclical
pattern.
2. Unexplained weight loss: 10% weight loss in six months duration is
considered as significant.
3. Pruritus: Irritating sensation that creates urge to scratch.
4. Bone pains: More after taking alcohol.
5. Cervical lymph nodes are nontender, smooth, rubbery and discrete.
6. Dyspnea and hoarseness of voice dur to superior vena cava compression.

11. On general examination there can be:
• Anemia
• Jaundice
• Enlargement of other groups of lymph nodes
• Hepatosplenomegaly
• Pleural effusion
• Edema effusion
• Red scaly patches of skin due to cutaneous involvement
(Mycosis Fungoides)

12. AIM
 To determine extent of disease.
 To plan treatment.
 To assess the prognosis.
STAGES
1. Stage I: Confined to one lymph node site.
2. Stage II: Involvement of more than one site, either all above or below the
diaphragm.
3. Stage III: Nodes involved above and below diaphragm.
4. Stage IV: Involvement of extralymphatics sites, e.g, liver,bone etc.

13. Clinical staging (Ann Arbor Staging)

14.  Chest X-ray to demonstrate enlarged nodes and pleural
effusion.
 Bone marrow biopsy may be required in case of haematological
abnormalities to look for bone marrow involvement.
 Lymph node biopsy: excision biopsy is best for establishing the
diagnosis and accurate histological grading.
 CT scan of abdomen for better delineation of structures.
 MRI
 PET Scan

15. CBC-Anemia and high WBC
LDH(Lactate dehydrogenase)-High
ESR- High
LFT- Helps determine the need for liver biopsy
Abnormal lab test

16. • Radiotherapy (RT) and chemotherapy (CT)
are the modes of treatment given according
to stages of the disease.
• Both RT and CT are toxic and can cause
bone marrow depression. CT causes
infertility in males.
• RT is given in stage I,II,IIIa. A total dosage of 3500-4000 rads is given over
a period of four weeks.
• CT is given in stage IIIb and IV. Multiple cytotoxic drugs are given along
with serious To produce better remission. It is called as “combination
chemotherapy”.