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1. Hodgkin’s
Disease/lymphomas

2. Hematopoietic System

3. B cell malignancies
Pre-B acute lympho-
blastic leukemia
B cell lymphoma Chronic lympho-
cytic leukemia
Multiple myeloma
Progressive B lymphocyte maturation
Bone marrow
Lymph node,
lymph, blood,
bone marrow
Lymph node,
lymph, blood,
bone marrow
Bone marrow
Lymphoid stem cell Maturing B cell
many stages
Mature B cell Plasma cell

4. Hodgkin’s Disease/Lymphoma
In the Beginning
1798-1866
First described in 1832 by Dr. Thomas Hodgkin
Neoplasm of B lymphocytes – large pleomorphic prominent
nucleolus in a halo - Hodgkin cells
Reed-Sternberg cell – binucleate Hodgkin cell with owl eye
appearance
Classification:
Classical Hodgkin’s
Nodular sclerosis – low grade
Mixed cellularity
Lymphocyte rich classical
Lymphocyte depleted. – high grade
Nodular lymphocyte-rich Hodgkin’s

5. Hodgkin’s Disease/Lymphoma
In the Beginning
 Bimodal age distributionBimodal age distribution
 first peak between 2first peak between 2ndnd
- 3- 3rdrd
decade of lifedecade of life
 second peak between 5second peak between 5thth
- 6- 6thth
decade of lifedecade of life
 Male: Female 2:1 in kids, adults almost equal M:FMale: Female 2:1 in kids, adults almost equal M:F
 Mixed cellularity (MC) Hodgkin’s Disease is moreMixed cellularity (MC) Hodgkin’s Disease is more
common at younger agescommon at younger ages
 More common in immune deficiency patientsMore common in immune deficiency patients

6. Hodgkin’s Disease/Lymphoma
In the Beginning
 Accounts for ~ 30% of all malignant lymphomasAccounts for ~ 30% of all malignant lymphomas
 Composed of two different disease entities:Composed of two different disease entities:
Lymphocyte-predominant Hodgkin’s (LPHD), making upLymphocyte-predominant Hodgkin’s (LPHD), making up
~ 5% of cases~ 5% of cases
Classical HD, representing ~ 95% of all HDs.Classical HD, representing ~ 95% of all HDs.
A common factor of both HD types is that neoplasticA common factor of both HD types is that neoplastic
cells constitute only a small minority of the cells incells constitute only a small minority of the cells in
the affected tissue, often corresponding to < 2% ofthe affected tissue, often corresponding to < 2% of
the total tumorthe total tumor

7. Fatal disease with 90% of untreated patients dying
within 2 to 3 years
With chemotherapy, >80% of patients suffering from
HD are cured.
Pathogenesis of HD is still largely unknown.
HD nearly always arises and disseminates in lymph
nodes
Hodgkin’s Disease/Lymphoma
In the Beginning

8. Hodgkin’s Disease/Lymphoma
Interest tidbits
 Pel-Ebstein Fevers
 Pain with alcohol consumption

9.  Nontender lymph nodes enlargement (localized)Nontender lymph nodes enlargement (localized)
 neck and supraclavicular areaneck and supraclavicular area
 mediastinal adenopathymediastinal adenopathy
 other (abdominal, extranodal disease)other (abdominal, extranodal disease)
 systemic symptoms (B symptoms)systemic symptoms (B symptoms)
 feverfever
 night sweatsnight sweats
 unexplained weight loss (10% per 6 months)unexplained weight loss (10% per 6 months)
 other symptomsother symptoms
 fatigue, weakness, pruritusfatigue, weakness, pruritus
 cough , chest pain, shortness of breath, vena cavacough , chest pain, shortness of breath, vena cava
syndromesyndrome
 abdominal pain, bowel disturbances, ascitesabdominal pain, bowel disturbances, ascites
 bone painbone pain
Hodgkin’s Disease/Lymphoma
Clinical Presentation

10. SIGNS & SYMPTOMS % OF PATIENTS
Lymphadenopathy 90
Mediastinal mass 60
“B” symptoms 30
Fever, weight loss, night sweats
Hepatosplenomegaly 25
 Most commonly involved lymph nodes are the
cervical and supraclavicular in 75%
 Bone marrow is involved in 5% of patients
Hodgkin’s Disease/Lymphoma
Clinical Presentation

11. Reed-Sternberg Cells

12. CD 30 Immunostain

13. Hodgkin’s Disease/Lymphoma
Clinical Presentation
Stage Definition
I Involvement of a single lymph node region (I) or of a single extralymphatic organ or site (IE)
II Involvement of two or more lymph node regions on the same side of the diaphragm (II) or
localized involvement of an extralymphatic organ or site and one or more lymph node regions on
the same side of the diaphragm (IIE)
III Involvement of lymph node regions on both sides of the diaphragm (III) which may be
accompanied by involvement of the spleen (IIIS) or by localized involvement of an
extralymphatic organ or site (IIIE) or both (IIISE)
IV Diffuse or disseminated involvement of one or more extra lymphatic organs or tissues with
or without associated lymph node involvement
B symptoms: fever > 38ºC for three consecutive days, drenching night sweats or unexplained loss 10% or more of
weight the preceding 6 months

14. Hodgkin’s Disease/Lymphoma
Treatment
Unfavorable prognostic factors:Unfavorable prognostic factors:
- Stage IIIB, IV- Stage IIIB, IV
- B symptoms- B symptoms
- Bulky disease- Bulky disease
- High ESR >50- High ESR >50

15.  Long term effects of treatment should beLong term effects of treatment should be
taken into consideration:taken into consideration:
- Treatment-related second neoplasms- Treatment-related second neoplasms
(i.e. AML, NHL and breast cancer)(i.e. AML, NHL and breast cancer)
- Infertility- Infertility
- Growth consideration- Growth consideration
- Long-term organ dysfunction (i.e.,- Long-term organ dysfunction (i.e.,
thyroid, heart, lung)thyroid, heart, lung)
Hodgkin’s Disease/Lymphoma
Treatment

16.  Adolescent patients who have achieved
maximum growth can be treated as adult
patients
 Chemotherapy alone protocols for
localized disease has been used in
developing countries with some success
Hodgkin’s Disease/Lymphoma
Treatment
Lobo-Sanahuja F: Medical and Pediatric Oncology 22(6);1994