Hodgkin's Disease
Hodgkin's disease is a disease of lymphocytes, in which there are Reed-Sternberg cells on a background of lymphocytes. Reed-Sternberg cells are small lymphocytes with large multinucleated nuclei, derived from malignant B cells, interspersed throughout a lymph node. These malignant cells spread from one lymph node group to another, in a sequential pattern.. Age distribution has a bimodal (two peak) frequency, affecting people in their teens and then the elderly. The frequency increases as someone ages.
Patients with Hodgkin's disease present with enlarged lymph nodes, most commonly in their neck. Cervical lymphadenopathy is found in 70% of patients, axillary (armpit) lymphadenopathy in 20%, and inguinal lymphadenopathy in 10%. Fevers, drenching night sweats and weight loss, more than 10%, are termed as "B symptoms" and are found in many patients with Hodgkin's. Once a group of lymph nodes are found, the disease usually spreads to another group of lymph nodes contiguously. The case of Hodgkin's disease is believed to be caused by the Ebstein Barr Virus.
Diagnosis is done through biopsy of an enlarged lymph node. This biopsy is then sectioned and stained, and sent to a pathology, which views to morphology of the cells within the node. Staging id done to determine the extent of disease. This is through physical examination, a complete blood count, liver enzymes as the cells can infiltrate the liver, imaging of the head and neck, chest, abdomen and pelvis, looking for any other enlarged lymph nodes not picked up on physical examination., and a bone marrow biopsy, to look for any marrow infiltration.
Stage I. One lymph node group involved
Stage II. more than 2 lymph node groups involved, same side of the diaphragm
Stage III. Nodes on both side of the diaphragm are involved
Stag IV. Extranodal sites are involved, such as the bone marrow, liver, etc...
An A or B is added to the stage to designate whether there are any symptoms: fevers, night sweats or weight loss. A means none are present. B designates whether any are present.
Early stage Hodgkin's Disease is treated with radiation and limited use of chemotherapy, as the disease is well-localized. Advanced stage disease requires chemotherapy as the disease has become widespread.
Prognosis is better in young patients. Early disease has a cure rate of 70-90%, while advanced disease is around 60-70%. These values have been slowly increasing over time.
1) Robbins and Cotran Pathologic Basis of Disease. Seventh Edition. Kumar, V., Abbas, A.K., and Fausto, N. 2005, Elsevier Inc.