Hodgkin and Non-Hodgkin Lymphoma

 

Malignant Lymphoma: cancerous tumor composed of uncontrollably growing peripheral lymphoid tissue cells. Both Hodgkin’s and Non-Hodgkin lymphomas are characterized by uncontrolled neoplastic growth of lymph tissue and in lymph nodes.

Hodgkin Lymphoma or Hodgkin Disease:

  • a group of cancers characterized by the presence of Reed-Sternberg cells.
  • This unicentric cancerous line spreads from a single lymph node by continuous extension along the lymphatic system.
  • Spread of cancerous cells is often along predictable lines
  • localization is common.
  • Epstein-Barr Virus Infection which has been linked to Hodgkin’s Lymphoma.

Non-Hodgkin Lymphoma:

  • a heterogenous group of cancers that originate from neoplastic B or T cell lymphoid tissue, cells of this cancer type may vary morphologically.
  • This multicentric cancer line metastasizes unpredictably.
  • Localization of disease is uncommon.
  • Epstein-Barr Virus has been linked to Burkitt Lymphoma
  • Human T cell lymphotrophic virus has been linked to adult T cell leukemia-lymphoma
  • Helicobactor pylori infection linked with MALT stomach lymphoma
  • has been linked to environmental toxins, viral infection and immunosuppressant states such as HIV/AIDS and immunosuppressant drug therapies such as those used in organ transplantation.

Reed-Sternberg cells: the malignant cell line of Hodgkin’s disease. Morphologically large cell thought to be of immature lymphoid cellular origin. When fewer Reed-Sternberg cells are present the cancerous spread is limited to fewer lymph nodes.

Hodgkin Lymphoma

Etiology: Idiopathic.

Risk Factors: with links to previous infection with Epstein-Barr Virus, immunosuppressant states such as HIV/AIDS and or organ transplantation. Research has indicated genetic predisposition for developing Hodgkin Lymphoma.

Pathophysiology:

  • disseminate via lymphatic system and blood vessel infiltration

Manifestation signs and symptoms: 

  • painless lymphadenopathy (due to pressure or obstruction)
  • enlarged lymph nodes may be evident in the supraclavicular, cervical regions
  • Involvement of extremities may manifest in pain, nerve irritation and obliteration of pulse
  • Systemic B symptoms = fever, night sweats, weight loss, pruritis, hepatomegaly and splenomegaly
  • non-productive cough (mediastinal mass)

Treatment – medical management:

  • Radiation is the primary treatment strategy in localized disease, stage 1 (single lymph node involvement) and stage 2 (involvement of 2 or more lymph nodes on the same side of the diaphragm).
  • Stage 3 treated with a combination of radiation and chemotherapeutic agents

Non-Hodgkin Lymphoma

Etiology: idiopathic.

Risk Factors:

correlations with environmental toxins, viral infections (EBV, human herpes virus 8), bacterial infections (Helicobactor pylori) and immunosuppressive states (HIV/AIDS and immunosuppressant drug therapies for organ transplants) have been implicated.

Pathophysiology: abnormal proliferation of neoplastic lymphocytic lineage.

Manifestations: Painless enlargement of lymph nodes. Symptoms arise as neoplasms impair and obstruct lymph nodes.

May include extranodal site metastasis to:

  • nasopharynx
  • GI tract
  • bone
  • thyroid
  • testes
  • abdomen

Systemic B symptoms may occur:

  • night sweats
  • fever
  • weight loss
  • hepatomegaly or splenomegaly may also occur

Treatment:

  • depends on histological type, stage of disease and clinical status of the person
  • radiation may be most effective for localized, early stages and non-aggressive forms
  • stages 1 and 2 may be effectively treated with chemotherapy and radiation
  • cranial radiation or intrathecal chemotherapy, in addition to systemic radiation may be used to treat more advanced stages
  • Monoclonal antibody therapy may also be used to specifically target antigens present on most B cell lymphoma cell surface

Martin, Glenn and Porth, Carol, Mattson. 2009. Pathophysiology Concepts of Altered Health States. 8th ed. Lippincott Williams and Wilkins. Philadelphia

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