-IBIS-1.5.0-
tx
immune system
lymphoma: Hodgkin's
diagnoses

definition and etiology

definition: A malignant disorder of the lymphoid tissue that begins in the lymph nodes and spreads to adjacent nodes then liver, spleen and bone marrow.

etiology: The cause is unknown, although researchers are working on an infectious theory. Most patients with Hodgkin's disease are men, and men have the worst prognosis. About half the cases occur between the ages of 20 and 40, with less than 10% of cases occurring in those less than 10 or older than 60. Normal lymph nodes are replaced by lymphocytic infiltration including characteristic Reed-Sternberg giant cells.

signs and symptoms

• Painless lymph node swelling: usually, the cervical nodes are involved.
• Other possible symptoms: Fever, malaise, sweating, weight loss, itching.
• Symptoms relating to other organ involvement especially in liver, spleen, retroperitoneal nodes and bone.

lab findings:
Blood findings vary from normal to marked abnormalities
• (+) Reed-Sternberg cells found in biopsy of lymph nodes
• WBCs may be normal, decreased, or increased as high as 25,000/mm3
• eosinophilia may be present
• lymphopenia or hemolytic anemia occurs in advanced disease
• lymphocytosis rules out Hodgkin's
• albumin often decreased, with increased alpha 1 and alpha 2 globulins
• may be evidence of autoimmune disease, with hemolytic anemia, cold agglutinins, and (+) LE test
• ESR and CRP may be increased during exacerbations
• increased serum alkaline phosphatase
• to detect nodal or organ involvement: chest x-ray, ultrasound, IVP, lymphangiography, CT scan, laparotomy
• (+) direct Coombs
• bone marrow biopsy
• Gallium-67 scintiphotography

course and prognosis

The prognosis is good, if liver and/or bone involvement has not yet occurred; it also depends upon the staging of the disease, and the type of lymphoma. Conventional treatment consists of radiation and/or chemotherapy and occasional splenectomy. Remission rates presently 70-90% at five years with that treatment.

differential diagnosis

• Non-Hodgkin's lymphoma.
• Acute or chronic leukemia.
• TB.
• Infectious mononucleosis.
• AIDS
• Toxoplasmosis.
• Metastatic carcinoma.


footnotes