Hodgkin's disease

Introduction to Hodgkin's disease Hodgkin's disease is a malignant tumor of lymphoid tissue. It often occurs in a group of lymph nodes and spreads to its lymph nodes and extranodal organs, which is more common in adolescents. Clinical manifestations include fever, night sweats, weight loss, fatigue, anemia, itchy skin, thickening, shedding, infection, low back pain, hepatosplenomegaly, and common lymphadenopathy. Hodgkin Lymphoma, formerly known as Hodgkin's disease, Hodgkin's disease, or Hodgkin's lymphoma. It is a cancer that stems from lymphocytes. The name "Hodgkin" is derived from Thomas Hodgkin's first description of the unique malignant disease of this lymphatic system in 1832. It often begins in a group of lymph nodes and then spreads to other lymph nodes or extranodal organs and tissues. Its histopathological features are the appearance of malignant Reed-Sternberg cells. At present, the application of chemotherapy, radiotherapy and bone marrow transplantation in the treatment of Hodgkin's lymphoma has made it a curable tumor. basic knowledge The proportion of illness: 0.03%--0.05% Susceptible people: good for teenagers Mode of infection: non-infectious Complications: lymphoma

The cause of Hodgkin's disease

The cause of Hodgkin's lymphoma is unknown, and the etiology of Epstein-Barr virus is the most concerned. Epstein-Barr virus genome fragments can be detected in RS cells of about 50% of patients. Increased risk of developing Hodgkin's lymphoma in patients with immunodeficiency and autoimmune diseases is known. Patients with monozygotic twin Hodgkin's lymphoma have a 99-fold increased risk of their siblings, probably due to the same genetic susceptibility and/or the same immune abnormality to the cause.

Hodgkin's disease prevention

Major measures for the prevention of malignant diseases of the blood system, including malignant lymphoma, should be taken to avoid causing the disease.

1) Prevent viral infections, such as Epstein-Barr virus, adult T-lymphocytic leukemia virus, HIV, etc., prevent colds in the spring and autumn, strengthen self-protection, and overcome bad habits.

2) Remove environmental factors such as avoiding exposure to various rays and some radioactive materials. Avoid contact with related toxic substances such as benzene, vinyl chloride, rubber, arsenic, gasoline, organic solvent coatings, etc.

3) Prevention and treatment of autoimmune deficiency diseases, such as low immune status after various organ transplants, autoimmune diseases, and various cancers after chemotherapy. Graft-versus-host disease or immunosuppressive agents can activate the virus and induce its proliferation of lymphoid tissues.

4) Patients with long-term survival should have regular chest and breast examinations every year to detect treatment-related complications and the possibility of a second tumor.

5) Maintain an optimistic and confident health mentality. Appropriate physical exercise will help stabilize the immune function of the body and promptly eliminate the invasion of external factors.

6) For early-stage diagnosis and early comprehensive treatment for people at risk or who discover risk factors. The treatment of this disease should be comprehensive, in addition to the treatment of the cause, but also nutritional supplements, if necessary, for central venous intubation and parenteral nutrition, supplement blood products as needed.

The success or failure of comorbidity prevention often has a major impact on the prognosis of the disease, especially the prevention and treatment of opportunistic infections in the immunosuppressive phase. Pay special attention to tuberculosis, fungal infections, hepatitis and cytomegalovirus infection.

Hodgkin's disease complications Complications lymphoma

Hodgkin's lymphoma is one of the most common malignancies among young people. Lesions mainly occur in lymph nodes, with cervical lymph nodes and supraclavicular lymph nodes being the most common, followed by mediastinal, retroperitoneal, and para-aortic lymph nodes. The lesion begins with one or a group of lymph nodes and usually manifests a regular spread from the primary tumor along the lymphatic to the adjacent lymph nodes. In the advanced stage, hematogenous spread can occur, invading blood vessels, involving the spleen, liver, bone marrow and digestive tract.

Hodgkin's disease symptoms Common symptoms Loss of appetite, night sweats, nausea, itching, high fever, low fever, abdominal pain, weight loss, herpes, thrombocytopenia

The common clinical manifestations of Hodgkin's lymphoma are as follows:

1) Lymph node enlargement is the most common clinical manifestation of Hodgkin's lymphoma. 90% of patients have lymph node enlargement, about 70% have cervical lymphadenopathy, and 50% have mediastinal lymphadenopathy. Lymph node enlargement is often painless and progressive. Lymph node enlargement can impair dysfunction and corresponding clinical manifestations of adjacent organ tissues. Such as one side of the body edema, chest and ascites, oliguria.

2) Clinical manifestations of involvement of extranodal organs: Hodgkin's lymphoma is rare in the primary organs or tissues of the lymph nodes (<10%). The primary or extranodal involvement of the lymph nodes may cause anatomical and dysfunction of the corresponding organs. , causing a variety of clinical manifestations. Common sites are the small intestine, stomach and pharyngeal lymphatic rings. Can involve the nervous system to cause paraplegia, involving bone fractures, can invade bone marrow, breast, thyroid and so on.

3) Systemic symptoms can occur in 55% of patients at the time of initial diagnosis, and 20% to 30% of patients show fever, night sweats, and weight loss. Fever can be low fever, and 1/6 of patients have periodic fever (Pel-Ebstein heat), which is characterized by a gradual increase in body temperature within a few days, reaching 38~40 °C, gradually decreasing after several days, after 10 days or more. During the period, the body temperature rises again and again, and the interval is gradually shortened. In addition, it may have itching, fatigue, and lymph node pain after drinking.

4) Clinical manifestations of different histological types: nodular lymphocytes dominated 4% to 5% of HL. The median age of onset was 35 years old, more common in men, and the ratio of men to women was 3:1. The lesion usually involves the surrounding lymph nodes. Most of the initial lesions are early localized lesions, and about 80% belong to stage I and II. The natural course is slow and the prognosis is good. The complete response rate for treatment is 90%, and the 10-year survival rate is about 90%. However, patients with advanced stage (III, IV) have a poor prognosis. The lymphocyte-rich classic Hodgkin's lymphoma accounts for about 6%, and the average age is larger, which is more common in men. The clinical features are between nodular lymphocyte-based and classic Hodgkin's lymphoma, often showing early limited lesions, rare massive lesions, mediastinal lesions and B symptoms, with a good prognosis, but the survival rate is better. NLPHL is low. The nodular sclerosis of classical Hodgkin's lymphoma is the most common in developed countries, accounting for 60% to 80%. More common in young adults and adolescents, slightly more women. Often manifested in the mediastinum and other parts of the lymph node lesions. The prognosis is good. Mixed cell types account for 15% to 30% in European and American countries. It can occur on different ages. Clinical manifestations of abdominal lymph node and spleen disease are common changes, about half of the patients have been in the advanced stage (stage III, IV), the prognosis is poor. Lymphocyte depletion is rare, about 1%. More common in the elderly and human immunodeficiency virus (HIV) infection. Often involved in the abdominal lymph nodes, spleen, liver and bone marrow, usually spread widely in the diagnosis, prone to blood spread. Often accompanied by systemic symptoms, the disease progresses rapidly and the prognosis is poor.

Clinical stage

The lesions of Hodgkin's lymphoma range from the Ann Arbor staging system:

Stage I lesions are limited to one lymph node area or to a single extranodal organ (IE).

Stage II lesions involve two or more lymph nodes in the ipsilateral side of the diaphragm, or lesions that invade the extranodal organs and more than one lymph node (IIE) on the same side of the diaphragm.

There were lymph node lesions in the third stage of the diaphragm. May be associated with spleen involvement (IIIS), extranodal organ involvement (IIIE), or spleen and localized extranodal involvement (IIISE).

One or more extranodal organs in stage IV are extensively disseminated, with or without lymphadenopathy. The liver or bone marrow is in stage IV as long as it is involved.

Group A: no systemic symptoms

Group B: Systemic symptoms: including unexplained fever (>38 ° C for three consecutive days) or night sweats or weight loss (10% or more within 6 months)

Hodgkin's disease check

Laboratory inspection

(1) Blood shows that anemia is more common in advanced patients, and it is positive pigment and positive cell anemia. Occasionally, hemolytic anemia, 2% to 10% of patients with positive Coombs test. In a few cases, neutrophilia may occur with immunological thrombocytopenic purpura. Whole blood cell reduction is seen in patients with advanced disease or lymphocyte depletion. Peripheral blood lymphocyte reduction (<1.0×10 ⁹ /L), increased erythrocyte sedimentation rate, and elevated serum lactate dehydrogenase can be used as indicators for disease monitoring. Biochemical examination can be seen high blood calcium, high blood sugar and so on.

(2) Immunological examination suggests that the disease has cellular immunodeficiency, showing a delayed skin immune response and a decrease in CD4+ cells.

Image examination

(1) X-ray plain film: Asymmetrical nodular shadows can usually be seen in the bilateral anterior and superior mediastinum.

(2) CT: multiple soft tissue masses can be seen, without necrosis, hemorrhage or cystic changes, and enhanced post-intensification scan. A swollen nodule can eventually lead to a significant mass effect.

(3) MR: A uniform signal lumps showing low T1WI signals and high T2WI signal intensity due to edema and inflammation. A low T2WI signal can help rule out the possibility of recurrence after treatment.

(4) PET-CT: The combination of FDG distribution and CT can effectively assess the extent of disease and the degree of recurrence. Testing after two courses of chemotherapy is an important basis for evaluating whether there are high risk factors for treatment failure and whether such patients can benefit from intensive treatment.

(5) Check bone X-ray and bone scan when suspected bone invasion.

Diagnosis and identification of Hodgkin's disease

diagnosis

The diagnosis of Hodgkin's lymphoma depends mainly on the pathological examination of the diseased tissue, so it is particularly important to perform a biopsy of the diseased lymph node or a thick needle biopsy of the deep tissue. After pathological diagnosis, the extent of the lesion should be determined according to systemic symptoms, physical examination, laboratory examination and imaging examination, and the clinical stage should be defined. Accurate staging is an important basis for developing a correct treatment plan.

Differential diagnosis

The differential diagnosis of this disease often needs to be differentiated from lymphatic tuberculosis, viral infections such as infectious mononucleosis, sarcoidosis and non-Hodgkin's lymphoma. And should pay attention to the identification of metastatic cancer. Cervical lymphadenopathy should exclude nasopharyngeal carcinoma, thyroid cancer, etc., mediastinal masses need to exclude lung cancer, thymoma, axillary lymphadenopathy should be differentiated from breast cancer. The identification of the above diseases mainly depends on histopathological examination. Clinicians should make a comprehensive diagnosis based on the patient's clinical manifestations and pathological findings, including the pathological type and clinical stage grouping of Hodgkin's lymphoma.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.