Normally, the lymph nodes are composed of connective tissues that surround a
fine mesh of reticular fibers and cells. In Hodgkin's lymphoma the normal
structure of lymph nodes is destroyed by hyperplasia of monocytes and
macrophages. The main diagnostic feature of Hodgkin's lymphoma is the
presence of Reed-Sternberg cells in lymph node biopsy specimens.
s/s
o
enlargement of cervical, axillary, or inguinal lymph nodes
o
mediastinal node second most common location
o
nodes are not painful unless they exert pressure on nerves
o
weight loss
o
fatigue
o
fever
o
chills
o
tachycardia
o
night sweats
o
A group of initial findings including fever (in excess of 100.4° F [38° C]), drenching
night sweats, and weight loss (exceeding 10% in 6 months) are termed B
symptoms and correlate with a worse prognosis
o
Pain when drinking alcohol
o
Skin lesions
o
Advanced: hepatomegaly and splenomegaly, anemia
7
Amanda Sacca
Care
o
standard for chemotherapy is the ABVD regimen: doxorubicin (Adriamycin),
bleomycin, vinblastine, and dacarbazine
o
more severe
BEACOPP (bleomycin, etoposide, doxorubicin (Adriamycin),
cyclophosphamide, vincristine (Oncovin), procarbazine, and prednisone)
Non-Hodgkin’s Lymphoma
heterogeneous group of malignant neoplasms of primarily B-, T-, or natural killer (NK)
cell origin affecting all ages
B-Cell lymphomas
T cell and NKcell lymphomas
patho
o
cause unknown; possible chromosomal translocations, environmental factors,
immunodeficiency states
o
no hallmark feature like reed-sternberg cells
o
mimic leukemia
o
Diffuse large B-cell lymphoma, the most common aggressive lymphoma, is a
neoplasm that originates in the lymph nodes, usually in the neck or abdomen.
o
Burkitt's lymphoma is the most highly aggressive disease and is thought to
originate from B-cell blasts in the lymph nodes.
s/s
o
NHLs can originate OUTSIDE the lymph nodes
o
Method of spread unpredictable
o
Primary clinical manifestation: painless lymph node enlargement
o
Usually
disseminated
when diagnosed
Other symptoms present depending where the disease has spread
o
Patients with high-grade lymphomas may have lymphadenopathy and
constitutional symptoms (B symptoms) such as fever, night sweats, and weight
loss.
Care
o
chemo and radiation
o
Weird --- more aggressive lymphomas (diffuse large B cell) are more responsive
to tx and more likely to be cured than indolent lymphomas that have naturally
long course but are difficult to treat
8
Amanda Sacca
Rituximab, a monoclonal antibody against the CD20 antigen on the surface of normal and
malignant B cells, is used to treat NHL. Once bound to the cells, rituximab causes lysis and cell
death. Numerous chemotherapy combinations have been used to try to overcome the resistant
nature of this disease (Table 30-29). Complete remissions are uncommon, but the majority of
patients respond with improvement in symptoms.
