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| {{Hodgkin's lymphoma}} | | {{Hodgkin's lymphoma}} |
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| {{CMG}}; {{AE}} {{AS}} | | {{CMG}} {{shyam}}; {{AE}} {{AS}} |
| ==Overview== | | ==Overview== |
| The diagnostic study of choice for Hodgkin's lymphoma is lymph node biopsy. In addition to light microscopy evaluation of the biopsy samples, the immunophenotypic analysis with immunohistochemistry helps to determine Hodgkin's lymphoma subtypes and distinguish Hodgkin's lymphoma from T cell rich large B cell lymphoma and anaplastic large cell lymphoma. | | The diagnostic study of choice for Hodgkin's lymphoma is excisional lymph node biopsy. A bone marrow biopsy is an alternative to a lymph node biopsy. |
| | ==Diagnostic study of choice== |
| | *The diagnostic study of choice for Hodgkin's lymphoma is excisional lymph node biopsy. An excisional biopsy is needed because it preserves the architecture of the lymph node and allows for precise determination of the type of lymphoma. Fine needle aspiration biopsy is insufficient. In addition to light microscopy evaluation of the excisional biopsy samples, the immunophenotypic analysis with immunohistochemistry helps to determine Hodgkin's lymphoma subtypes and distinguish Hodgkin's lymphoma from T cell rich large B cell lymphoma and anaplastic large cell lymphoma. The presence of Reed-Sternberg cells is diagnostic for classic Hodgkin's lymphoma. The Reed-Sternberg cells of classic Hodgkin's lymphoma particularly express CD15 and CD30 and do not present CD3 or CD45. Flow cytometry is an effective method in differentiating between classic Hodgkin's lymphoma, nodular lymphocyte predominant Hodgkin's lymphoma, and T cell rich large B cell lymphoma based upon the presence of specific T cell populations.<ref name="pmid27365459">{{cite journal| author=Vardhana S, Younes A| title=The immune microenvironment in Hodgkin lymphoma: T cells, B cells, and immune checkpoints. | journal=Haematologica | year= 2016 | volume= 101 | issue= 7 | pages= 794-802 | pmid=27365459 | doi=10.3324/haematol.2015.132761 | pmc=5004458 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27365459 }} </ref> |
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| According to the Lugano classification and Cotswold's modification of the original Ann arbor staging system, there are four stages of Hodgkin's lymphoma based on the number of nodes and extranodal involvement.
| | *A bone marrow biopsy can also be done to diagnose Hodgkin lymphoma if there is sufficient evidence of marrow involvement (i.e. presence of cytopenias). Hodgkin lymphoma cells originate in the bone marrow, which is the site of B cell production and maturation. A length of 2cm of the core biopsy is generally needed for diagnosis, which is in contrast to diagnostic requirements for leukemias. A bone marrow is not the diagnostic study of choice for Hodgkin lymphoma if a lymph node can be biopsied. |
| ==Staging==
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| The diagnostic study of choice for Hodgkin's lymphoma is lymph node biopsy. In addition to light microscopy evaluation of the biopsy samples, the immunophenotypic analysis with immunohistochemistry helps to determine Hodgkin's lymphoma subtypes and distinguish Hodgkin's lymphoma from T cell rich large B cell lymphoma and anaplastic large cell lymphoma.<ref>{{Cite journal
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| | author = [[R. von Wasielewski]], [[M. Mengel]], [[R. Fischer]], [[M. L. Hansmann]], [[K. Hubner]], [[J. Franklin]], [[H. Tesch]], [[U. Paulus]], [[M. Werner]], [[V. Diehl]] & [[A. Georgii]]
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| | title = Classical Hodgkin's disease. Clinical impact of the immunophenotype
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| | journal = [[The American journal of pathology]]
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| | volume = 151
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| | issue = 4
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| | pages = 1123–1130
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| | year = 1997
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| | month = October
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| | pmid = 9327746
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| }}</ref>
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| According to the Lugano classification<ref>{{Cite journal| doi = 10.1200/JCO.2013.54.8800| issn = 1527-7755| volume = 32| issue = 27| pages = 3059–3068| last1 = Cheson| first1 = Bruce D.| last2 = Fisher| first2 = Richard I.| last3 = Barrington| first3 = Sally F.| last4 = Cavalli| first4 = Franco| last5 = Schwartz| first5 = Lawrence H.| last6 = Zucca| first6 = Emanuele| last7 = Lister| first7 = T. Andrew| last8 = Alliance, Australasian Leukaemia and Lymphoma Group| last9 = Eastern Cooperative Oncology Group| last10 = European Mantle Cell Lymphoma Consortium| last11 = Italian Lymphoma Foundation| last12 = European Organisation for Research| last13 = Treatment of Cancer/Dutch Hemato-Oncology Group| last14 = Grupo Español de Médula Ósea| last15 = German High-Grade Lymphoma Study Group| last16 = German Hodgkin's Study Group| last17 = Japanese Lymphorra Study Group| last18 = Lymphoma Study Association| last19 = NCIC Clinical Trials Group| last20 = Nordic Lymphoma Study Group| last21 = Southwest Oncology Group| last22 = United Kingdom National Cancer Research Institute| title = Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma: the Lugano classification| journal = Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology| date = 2014-09-20| pmid = 25113753}}</ref> and Cotswold's modification of the original Ann arbor staging system,<ref name="radio">Hodgkin lymphoma. Dr Amir Rezaee and Dr Frank Gaillard et al. Radiopaedia.org 2015.http://radiopaedia.org/articles/lymphoma-staging</ref><ref>Hodgkin-lymphoma. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/hodgkin-lymphoma/staging/?region=ab Accessed on September 11, 2015</ref> there are four stages of Hodgkin's lymphoma based on the number of nodes and extranodal involvement.
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| Staging for Hodgkin's lymphoma is provided in the following tables:
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| {| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
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| |+ '''Revised staging system for primary nodal lymphomas (Lugano classification)'''
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| ! style="background: #4479BA; color:#FFF;" | Stage
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| ! style="background: #4479BA; color:#FFF;" | Involvement
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| ! style="background: #4479BA; color:#FFF;" | Extra nodal (E) status
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| |-
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| | colspan="3" style="padding: 5px 5px; background: #DCDCDC;" | '''Limited'''
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| |-
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| | style="padding: 5px 5px; background: #F5F5F5;" | I
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| | style="padding: 5px 5px; background: #F5F5F5;" | One node or a group of adjacent nodes
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| | style="padding: 5px 5px; background: #F5F5F5;" | Single extra nodal lesions without nodal involvement
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| |-
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| | style="padding: 5px 5px; background: #F5F5F5;" | II
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| | style="padding: 5px 5px; background: #F5F5F5;" | Two or more nodal groups on the same side of the diaphragm
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| | style="padding: 5px 5px; background: #F5F5F5;" | Stage I or II by nodal extent with limited contiguous extra nodal involvement
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| |-
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| | style="padding: 5px 5px; background: #F5F5F5;" | II bulky*
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| | style="padding: 5px 5px; background: #F5F5F5;" | II as above with "bulky" disease
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| | style="padding: 5px 5px; background: #F5F5F5;" | Not applicable
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| |-
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| | colspan="3" style="padding: 5px 5px; background: #DCDCDC;" | '''Advanced'''
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| |-
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| | style="padding: 5px 5px; background: #F5F5F5;" | III
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| | style="padding: 5px 5px; background: #F5F5F5;" | Nodes on both sides of the diaphragm; nodes above the diaphragm with spleen involvement
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| | style="padding: 5px 5px; background: #F5F5F5;" | Not applicable
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| |-
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| | style="padding: 5px 5px; background: #F5F5F5;" | IV
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| | style="padding: 5px 5px; background: #F5F5F5;" | Additional noncontiguous extra lymphatic involvement
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| | style="padding: 5px 5px; background: #F5F5F5;" | Not applicable
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| |}
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| {| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
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| |+ '''Cotswold's modification of the original Ann arbor staging system'''
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| ! style="background: #4479BA; color:#FFF;" | Stage
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| ! style="background: #4479BA; color:#FFF;" | Involvement
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| |-
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| | colspan="3" style="padding: 5px 5px; background: #DCDCDC;" | '''stage I'''
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| |-
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| | style="padding: 5px 5px; background: #F5F5F5;" | I
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| | style="padding: 5px 5px; background: #F5F5F5;" | One nodal group or lymphoid organ (e.g. spleen or thymus)
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| |-
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| | style="padding: 5px 5px; background: #F5F5F5;" | IE
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| | style="padding: 5px 5px; background: #F5F5F5;" | One extra nodal site
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| |-
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| | colspan="3" style="padding: 5px 5px; background: #DCDCDC;" | '''stage II'''
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| |-
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| | style="padding: 5px 5px; background: #F5F5F5;" | II
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| | style="padding: 5px 5px; background: #F5F5F5;" | Two or more nodal groups, same side of diaphragm
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| |-
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| | style="padding: 5px 5px; background: #F5F5F5;" | II E
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| | style="padding: 5px 5px; background: #F5F5F5;" | Localized extra nodal site with stage II criteria, both on the same side of the diaphragm
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| |-
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| | colspan="3" style="padding: 5px 5px; background: #DCDCDC;" | '''stage III'''
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| |-
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| | style="padding: 5px 5px; background: #F5F5F5;" | III
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| | style="padding: 5px 5px; background: #F5F5F5;" | Nodal groups on both sides of the diaphragm
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| |-
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| | style="padding: 5px 5px; background: #F5F5F5;" | III S (1)
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| | style="padding: 5px 5px; background: #F5F5F5;" | With splenic involvement
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| |-
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| | style="padding: 5px 5px; background: #F5F5F5;" | III E (2)
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| | style="padding: 5px 5px; background: #F5F5F5;" | With localized extra nodal site
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| |-
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| | style="padding: 5px 5px; background: #F5F5F5;" | III SE
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| | style="padding: 5px 5px; background: #F5F5F5;" | Both
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| |-
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| | colspan="3" style="padding: 5px 5px; background: #DCDCDC;" | '''stage IV'''
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| |-
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| | style="padding: 5px 5px; background: #F5F5F5;" | IV
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| | style="padding: 5px 5px; background: #F5F5F5;" | Disseminated involvement of one or more extra lymphatic organ (e.g. lung, bone) +/- any nodal involvement
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| |-
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| | colspan="3" style="padding: 5px 5px; background: #DCDCDC;" | '''Additional staging variables'''
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| |-
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| | style="padding: 5px 5px; background: #F5F5F5;" | X
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| | style="padding: 5px 5px; background: #F5F5F5;" | Bulky nodal disease: nodal mass >1/3 of intra thoracic diameter or 10 cm in dimension
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| |-
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| | style="padding: 5px 5px; background: #F5F5F5;" | A
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| | style="padding: 5px 5px; background: #F5F5F5;" | Asymptomatic
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| |-
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| | style="padding: 5px 5px; background: #F5F5F5;" | B
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| | style="padding: 5px 5px; background: #F5F5F5;" | Presence of B symptoms (fever, night sweats and weight loss)
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| |-
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| | style="padding: 5px 5px; background: #F5F5F5;" | E
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| | style="padding: 5px 5px; background: #F5F5F5;" | Extra nodal: other than the lymph nodes or spread to tissues beyond, but nearby, the lymphatic tissues
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| |-
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| | style="padding: 5px 5px; background: #F5F5F5;" | S
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| | style="padding: 5px 5px; background: #F5F5F5;" | Spleen
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| |-
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| | style="padding: 5px 5px; background: #F5F5F5;" | N
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| | style="padding: 5px 5px; background: #F5F5F5;" | Lymph nodes
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| |-
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| | style="padding: 5px 5px; background: #F5F5F5;" | H
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| | style="padding: 5px 5px; background: #F5F5F5;" | Liver
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| |-
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| | style="padding: 5px 5px; background: #F5F5F5;" | L
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| | style="padding: 5px 5px; background: #F5F5F5;" | Lung
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| |-
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| | style="padding: 5px 5px; background: #F5F5F5;" | M
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| | style="padding: 5px 5px; background: #F5F5F5;" | Bone marrow
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| |-
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| | style="padding: 5px 5px; background: #F5F5F5;" | O
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| | style="padding: 5px 5px; background: #F5F5F5;" | Bone
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| |-
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| | style="padding: 5px 5px; background: #F5F5F5;" | D
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| | style="padding: 5px 5px; background: #F5F5F5;" | Skin
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| |}
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| <gallery>
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| File: Stage_1_Hogkin's_lymphoma.png|Stage 1 Hodgkin's lymphoma
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| File: Stage_2_Hodgkin's_lymphoma.png|Stage 2 Hodgkin's lymphoma
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| File: Stage_3_Hodgkin's_lymphoma.png|Stage 3 Hodgkin's lymphoma
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| File: Stage_4_Hodgkin's_lymphoma.png|Stage 4 Hodgkin's lymphoma
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| </gallery>
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| ==References== | | ==References== |
| {{reflist|2}} | | {{reflist|2}} |
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| | {{WH}} |
| | {{WS}} |
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| [[Category:Disease]] | | [[Category:Disease]] |
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| [[Category:Rare diseases]] | | [[Category:Rare diseases]] |
| [[Category:Mature chapter]] | | [[Category:Mature chapter]] |
| [[Category:primary care]]
| | [[Category:Up-To-Date]] |
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| {{WH}}
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| {{WS}}
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| [[Category:Up-To-Date]]
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| [[Category:Oncology]] | | [[Category:Oncology]] |
| [[Category:Medicine]] | | [[Category:Medicine]] |
| [[Category:Hematology]]
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| [[Category:Immunology]] | | [[Category:Immunology]] |