Pathophysiology
1) neoplasm of B cell lymphocytes with presence of Reed-Sternberg cells 2) classical variants – nodular sclerosis (most common), lymphocyte-rich, mixed cellularity, and lymphocyte poor
Signs and Symptoms
1) nontender lymphadenopathy, especially cervical and axillary (usual presenting sign) 2) splenomegaly 3) episodic fevers (Pel-Ebstein fevers) 4) night sweats 5) weight loss 6) pruritus 7) pain on alcohol ingestion
Characteristic Test Findings
Laboratory – 1) mild anemia 2) neutrophilia and eosinophilia 3) increased sed rate 4) decreased circulating lymphocytes Radiology – 5) osteolytic bone destruction
Histology/Gross Pathology
1) Reed-Sternberg cells – have binucleated, mirror-imge morphology (most common in mixed cellularity variant) 2) Hodgkin’s cells – look like Reed-Sternberg cells but have only one nuclei (commonly seen in all variants) 3) “popcorn cells” with multiple nuclei and scant cytoplasm (most common in lymphocyte predominant variant) 4) cut surface of lymph nodes have “fish flesh” appearance 5) enlargement in spleen of white pulp only
Associated Conditions
1) increased risk with ataxia-telangiectasia (100 times), HIV/AIDS, infection with Ebstein Barr (EBV), rheumatoid arthritis, and HLA-B18 2) post-treatment patients have increased risk of – acute myelogenous leukemia (5%) and large-cell lymphoma (5%)
Biochemistry
marked by deficient delayed-type hypersensitivity reactions (deficient T cell function)
Inheritance/Epidemiology
1) 8000 new cases in USA each year 2) more common in whites and males 3) bimodal age distribution at diagnosis (in 20s and 80s) 4) young patients – nodular sclerosing variant most common 5) old patients and third-world countries – mixed cellular most common 6) young women – nodular sclerosing most common 7) best prognosis – nodular sclerosing and then lymphocyte predominant
Treatment
1) radiation and/or chemotherapy 2) some stage 2 patients and all stage 3 and 4 patients receive a “staging laparotomy” of splenectomy, liver biopsy, lymph node biopsy, and bone marrow biopsy
Tips for USMLE
1) if Reed-Sternberg is mentioned, think Hodgkin’s 2) if question mentions a 21 year-old male with fevers and enlarged but nontender neck nodes, think Hodgkin’s 3) 20-40% of Hodgkin’s patients have proliferation of Ebstein-Barr infected cells 4) Hodgkin’s cells occur in diseases other than Hodgkin’s disease
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