Hey guys, how are things? I'm so excited today to continue our discussion on hematology. And today, it's time.. for Hodgkin's lymphoma As you know, Hematological malignancies are leukemias, lymphomas, or myeloma Lymphoma: is a solid tumor of the lymphatic system, or lymphoid tissue such as: lymph node, spleen Mucosa-associated lymphatic tissue,...etc Lymphoma is divided into Hodgkin's lymphoma, and non-Hodgkins lymphoma. Hodgkin's is less common than non-hodgkin's. Hodgkins is a local disease, with Reed Sternberg cells. So, imagine that the genie appeared to you and told you: "you have been cursed by a lymphoma"! Which one should you choose? -Of course, You should choose... Hodgkin's lymphoma, because it's less evil than non-Hodgkin's. your chance of survival with Hodgkins is better than that with non-Hodgkins lymphoma. Represents 40 percent of adult lymphoma. Commoner in males than females, with the exception of nodular sclerosing subtype. remember roses for the female (Mnemonic: sclerosis = roses = female) More common in Caucasian. Has bimodal age distribution; The first peak is around 15 to 34 years of age and the second peak; to patients older than 50 years of age. Patients of Hodgkin's disease are usually younger than those of non-hodgkin's So Hodgkin's is a disease of the young! Usually starts in the cervical lymph nodes causing cervical lymph adenopathy, which is painless. HIV patients have higher risk of Hodgkin's disease and Hodgkin's is associated with a defect in cell mediated immunity Did you know that exposure to benzene can lead to Hodgkin's lymphoma? Exposure to benzene can lead to acute leukemia as well Hodgkin's disease has a complication of causing acute lymphoblastic leukemia Hodgkin's is associated with Epstein Barr virus Hodgkin's is more common in patients with History of mono because it makes perfect sense since infectious mononucleosis is with epstein-barr virus (EBV) Contiguous spread is common in Hodgkin's lymphoma. Which means from this lymph node to this lymph node to the next lymph node to the next one node in the same local area This is different from non Hodgkin's lymphoma, Where there is distant spread. There is lymphadenopathy in Hodgkin's, absolutely. It's localized and it's painless remember painful infection? painless malignancy Secondary amyloidosis; the serum amyloid A protein or SAA protein. Hodgkin's can be treated youth using Radiation which will lead to non Hodgkin's so you're trying to treat Hodgkin's using radiation But now you end up with non-Hodgkin's. Talking about misfortune!!! The classification of Hodgkin's is nodular lymphocyte predominance or Classic Hodgkin's. Classic Hodgkin's is more common Classic Hodgkin's has four subtypes: Nodular sclerosis is by far the most common; it's commoner in females roses lymphocyte rich, mixed cellularity Lymphocyte depleted: they're the worst subtype. So let's talk more about these subtypes. You have nodular lymphocyte predominance? 5% of cases and carries good prognosis nodular sclerosis the most common subtype Females more than males roses women and Children are the typical patients. It's the most common subtype of the classic Hodgkin's Anterior mediastinal nodes are often involved. It has an excellent prognosis...the best prognosis all of all of these are the nodules chlorosis. It has the lacunar type reed Sternberg so which is a reed Sternberg sole variant Lymphocyte rich, it's rich. So it carries very good prognosis Lymphocyte depleted on the other hand it's depleted. So it has the poorest survival bad prognosis it's the most aggressive of one and Thankfully, it's the least common it's depleted. Okay Mixed cellularity the name has the answer. It has more than one cell it has if Sinha fills plasma cells histiocytes etc a disease of the elderly Abdominal lymph nodes and spleen are often involved So remember nodular sclerosis commoner and females good prognosis lymphocyte Rich, very good prognosis a lymphocyte depleted very bad prognosis mixed cellularity more than one cell There is a genetic component to Hodgkin's disease Nuclear factor Kappa light chain. It's is a transcription factor. It will undergo Activation by epstein-barr virus or other factors now we turn the switch on Genes that promote proliferation are now on leading to proliferation proliferation proliferation proliferation which is cancer Now, let's turn our attention to lymph adenopathy in Hodgkin's disease. It's localized It's painless It starts in the cervical nodes the supraclavicular and the interior Mediastinal are also common. If you do a biopsy to this lymph node, and we use a core needle biopsy Never use fine needle aspiration. We need a core needle biopsy for lymphoma Ungrown appearance. You'll have bulging fish flesh appearance rubbery inconsistency a good pathologist can feel the lymph node and Tell this is very rubbery I can tell it's gonna be Hodgkin's it takes a slice put it under the microscope and Wow Here we have the Reda Sternberg cell and we confirm the diagnosis of Hodgkin's lymphoma That's a good pathologist that uses all of his senses to diagnose the disease and instead of just like a lab technician Just reads rumors all therefore Hodgkiss. No medicine is an art Microscopic appearance, there is Sternberg. So which are positive for CD 15 and CD 30? Here's a side note. Did you know causes of mediastinal masses are the famous forties? Thyroid mass thymoma Teratoma and terrible lymphoma the terrible lymphoma is Hodgkin's which subtype? Nodular sclerosis, and usually the patient is a female Lymphoma in the mediastinum only too short of breath and dry cough. Clinically. We have lymph adenopathy We have fever the fever comes the fever goes the fever comes the fever goes Comes and goes in a cyclical manner we call this Pelle Epstein fever itching is common splenomegaly, but not massive contrast that with CML that had massive splenomegaly nephrotic syndrome is common, especially Minimal change disease think about it minimal change disease is a disease of the young Hodgkin's disease the disease of the young they go together Obstructive jaundice of lymph adenopathy involve that porta hepatis, which is the door of the liver skin, erythema, nodosum CNS cerebellar degeneration autoimmune hemolytic anemia Yes in Hodgkin's disease as well as CLL Pain and lymph nodes on alcohol consumption is a very specific sign. It's not sensitive It's not common, but it's very specific Epstein Barr virus can cause Hodgkin's disease as well as non-hodgkins lymphoma it commonly causes non-hodgkins lymphoma even more than Hodgkin's cancer caused by EBV nasopharyngeal carcinoma Burkitt's lymphoma Hodgkin's lymphoma primary CNS lymphoma post organ transplant lymphoma the evil Epstein Barr So today we have finished talking about Hodgkins in the next videos. We will talk about diagnosis and treatment reached cerebrum So mnemonic about Hodgkins case not only one case but 10 cases Or 10 questions on Hodgkins then a quick review So I think you should subscribe to my channel and subscription doesn't mean anything because YouTube wants you to head that notification if you really like the channel and like to get notifications Facebook Twitter, SoundCloud Instagram You can support this channel on patreon and I will love you so much until next time be safe Stay happy and study hard medicos is perfection Alice