2. Collection of lymphoid malignancies in which
malignant lymphocytes accumulate in lymph
nodes and lymphoid tissues, leading to
lymphadenopathy, extra nodal disease and
constitutional symptoms.

4. Malignant proliferation of lymphoid cells with
Reed-Sternberg cells (thought to arise from
germinal center B-cells)
 Bimodal distribution with peaks at the age
of 20-30 years and >50 years
 Association with Epstein-Barr virus in up to
50% of cases
 M>F

5.  Classic:
 Nodular Sclerosis
 Lymphocyte rich
 Mixed Cellularity
 Lymphocyte depleted
 Non-Classic:
 Nodular Lymphocyte predominant
*REAL – Revised European American lymphoma

6.  Stage I
involvement of a single lymph node region or extra
lymphatic organ or site
 Stage II
involvement of two or more lymph node regions or
(IIe) an extra lymphatic site and one or more lymph node regions on
same side of diaphragm
 Stage III
involvement of lymph node regions on both sides of
the diaphragm; may (IIIe) or may not (III) be accompanied by single
extra lymphatic site or (IIS) splenic involvement or both (IISe)
 Stage IV
diffuse involvement of one or more extra lymphatic
organs (BM and liver)

7. subtypes:
A = absence of B symptoms
B = presence of B symptoms

9.  Asymptomatic lymphadenopathy (70%)
 most often cervical region
 asymmetrical, discrete
 painless, non-tender
 elastic character on palpation ( rubbery)
 not adherent to skin
 fluctuate in size
 Cervical/ Supra clavicular (60-80%), Axillary (10-
20%),Inguinal (6-12%)
Contiguous spread via the lymphatic chain eg. involvement
of abdominal & thoracic LNs

10.  Splenomegaly (50%) ± Hepatomegaly
 Mediastinal mass found on routine CXR, may be
symptomatic (cough) rarely may present with
SVC syndrome, pleural effusion
 Constitutional symptoms ( B symptoms )
 Night sweats,
 sustained fever > 38 degree Celsius (in 30% pts.),
 loss of weight >10% of body weight in 6 months

11.  Fever sometimes cyclical (‘Pel-Ebstein fever’)
 Alcohol induced pain in nodes
 Neprotic syndrome
 Pallor
 Pruritis
 Symptoms of Bulky (>10 cm) disease

12.  Inflammatory processes
 Mononucleosis
 Non-hodgkin’s lymphoma
 Phenytoin-induced adenopathy
 Non lymphomatous malignancies

13. Chronic hodgkin’s lymphoma in a 11year old

14.  CBC:
Anemia ( normochromic / normocytic),
eosinophilia, neutrophilia, lymphopenia, platelets
normal or increased early, decreased in advanced
disease
 ESR –raised(monitor disease progression)
 LFT- (liver infil / obs at porta hepatis)
 RFT- prior to treatment
 ALP, Ca (Bone involvement)
 LDH - adverse prognosis
 CXR- mediastinal mass
 CT thorax / abdomen / pelvis-for staging
 Other: Gallium scan (asses t/t response), PET, Bipedal
Lymphangiography , Laporotomy (for staging)

15.  LN FNAC / biopsy :
 Malignant REED-STERNBERG ( RS) Cell: Bi-nucleate cell
with a prominent nucleolus. Derived from B cell, at an early
stage of differentiation
 Reactive background of eosinophils, lymphocytes, plasma
cells
 Fibrous tissue
bone marrow biopsy to assess marrow infiltration (only
necessary if B symptoms, stage III or IV, bulky
disease or cytopenia)

17. a large cell with a bilobed nucleus and prominent
nulceoli giving owl’s eye appearance

18.  Cardiac Function Assessment - ( Echo for EF)
for pts at high
risk of pre-treatment cardiac disease
(age :>60, history of HT, CHF, CAD, MI, CVA)
 PFTs - if history of lung disease
(COPD, Smoking, Previous radiation to lung)

20. Nodular sclerosis type

22. Spleen in hodgkin’s

23. Stage 1 in hl

24. >10 cm
Bulky disease

26. Lymphangiography

27.  Stage IA , Stage IIA with 3 or < 3 areas involved:
Radiotherapy
 Stage IB, Stage II A with > 3 areas , Stage IIB:
Chemotherapy (every 3-4 weeks, 6-8 cycles; either alone,
or in combination with radiotherapy) =>ABVD
 Stage III & IV :
Chemotherapy (ABVD, BEACOPP) + Radiotherapy ( for bulky
disease or palliation of symptoms)
 Relapse, resistant to therapy: high dose chemotherapy,
bone marrow transplant
BEACOPP( bleomycin, etoposide, adriamycin, cyclophosphamide,
vincristine, procarbazine, prednisolone)
ABVD(Adriamycin, Bleomycin, Vinblastin, Dacarbazine)

28. Irradiation fields used in Hodgkin’s Lymphoma

29.  Cardiac disease - 2° to XRT, adriamycin is cardio toxic
 Pulmonary disease - secondary to bleomycin ( interstitial
pneumonitis)
 Infertility - recommend sperm banking
 Secondary Malignancy in irradiated field
2% risk of MDS, AML (2° to treatment, usually within 8 years)
• solid tumors of lung, breast, >10 years after treatment
• non-Hodgkin's lymphoma
 Hypothyroidism - post XRT
 Infection - post splenectomy (give Pneumovax, HiB, and
pneumococcal conjugate vaccines), during treatment

30. 1. Serum Albumin <4 gm/dL
2. Hemoglobin <10.5 gm/ dL
3. Male
4. Stage IV disease
5. Age:<45 years
6. Leukocytosis (WBC >15000 cells/dL)
7. Lymphocytopenia (lymphocytes <8% of WBC)