This histological slide shows a binucleate cell from a cervical lymph node biopsy. It is a
Reed-Sternberg cell and the diagnosis is that of Hodgkin's lymphoma. The malignant lymphomas are divided
into Hodgkin's and non-Hodgkin's groups. Hodgkin's disease was first described by Sir Thomas Hodgkin in
1832. The disease can present at any age but is more prevalent in adolescents and young adults. The male
to female ratio is 2:1. It usually presents as painless rubbery lymphadenopathy involving the superficial lymph
node groups. The cervical, axillary and inguinal nodes are involved in 70%, 15% and 10% of patients
respectively. Splenomegaly occurs in 50% of patients. Mediastinal involvement occurs in about 10% of
patients and this is characteristic of the nodular sclerosing type. Cutaneous involvement can occurs as a late
complication. Constitutional symptoms can develop in patients with widespread disease and these include a
remitting fever (Pel-Ebstein fever), pruritus and alcohol-induced pain. The diagnosis is confirmed by
lymph node biopsy.
Four histological types are identified
- Lymphocyte predominant (5%) - best prognosis
- Nodular sclerosing (65%) - worst prognosis
- Mixed cellularity (25%)
- Lymphocyte depleted (5%)
The disease is staged by the use of chest x-ray, bone marrow biopsy and abdominal and thoracic CT scan.
Before the advent of CT, staging laparotomy was required but this has now been rendered obsolete. The following
stages are recognised
- Stage I Confined to one lymph node group
- Stage II Disease confined to two or more nodal groups on one side of
- Stage III Disease involving nodes on both sided of the diaphragm
- Stage IV Extra-nodal disease - usually involving the liver and bone marrow
Patients with substage A disease have no constitutional symptoms. Patients with substage B disease have
constitutional symptoms that include an unexplained fever more than 38 deg C, night sweats and weight loss.
The treatment of Stage I and II disease is usually with radiotherapy. Stage III and IV disease is often
treated by both chemotherapy and radiotherapy. Stage I disease has a 5-year survival of 90%. Stage
IV has a 5 year survival of 60%.
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