Hodgkin lymphoma
| The one linked with EBV | |
|---|---|
| Etiology | Cancer of mature B cells Reed-Sternberg cells quoted as having EBV antigens in 20-40% cases |
| Epidemiology | biphasic incidence – young adults and elderly. Risk factors: affected sibling, EBV, SLE, post-transplantation, obesity |
| Clinical presentation | Painless cervical/supraclavicular lymphadenopathy B symptoms; "rubbery" cervical LNA; lymph nodes may be painful on alcohol consumption in 10%. Mediastinal mass can cause SVCO |
| Pathogenesis | |
| Diagnostic investigations | LN excision biopsy FBC: ↓ Hb, Plt Lymph node biopsy: Hodgkin-Reed Sternberg cell (“mirror image nuclei”) = ~CD30+ |
| Management | 80-90% curable! Radiotherapy has some role but often widespread ➥ Stage I-II = 2x ABVD + 20Gy radiotherapy; I-II with risk factors = 4x ABVD ➥ Advanced: 6x ABVD 80-85% cure ➥ Monitor for late toxicity- lung, cardiac, fertility, Ca breast ➥ New: risk-adapted therapy, anti-CD30, checkpoint inhibitors |