Introduction to Hodgkin's Lymphoma (HL)

Introduction: Hodgkin?s disease, also known as lymphoreticular sarcoma, is a chronic progressive, painless lymphoid tissue tumor with a predominantly eccentric tumor that originates from one or a group of lymph nodes. It is more common in the primary lymph nodes, gradually spread to adjacent lymph nodes, and then invades the spleen, liver, bone marrow and lungs. Due to the different sites of the disease, its clinical manifestations are diverse. There is very little morbidity before the age of 5, and gradually increases after the age of 5, the incidence of puberty is significantly increased, and the peak is 15 to 34 years old. There are more males than females. The ratio of male to female is 3:1 for 5 to 11 years old and 1.5:1 for 19 to 19 years old. Causes: Newly diagnosed cases in the United States each year have 6000~7000. The ratio of male to female is 1.4:1.10 years old is rare; the distribution of two age peaks is 15~34 years old and 60 years old respectively. Since most of 60 years old The case was diagnosed as non-Hodgkin's lymphoma (see below, so the second peak may be caused by human factors with inaccurate pathological diagnosis. Epidemiological studies have not found parallel evidence. The cause is unknown, but the patient seems to be present Genetic susceptibility and environmental relevance (eg, loggers; Epstein-Barr virus infection; HIV infection). Lymph node enlargement, normal structural destruction, partial or complete replacement by tumor tissue. Microscopically, lymph nodes are infiltrated, such as granulomas. It can be seen that single-core or multi-core Sternberg-Reed cells, lymphocytes, eosinophils and plasma cells are infiltrated, and fibrous tissue formation can be found. Finding S-Ray cells is the basis for diagnosis of this disease. It is found that different pathological changes have a great relationship with prognosis. In order to adopt different effective treatments, it is necessary to further classify. At present, Rye classification is adopted internationally and domestically, and the left side is divided into four according to the prognosis. 1. lymphocyte dominant type; 2. nodular sclerosis type; 3. mixed type; 4. lymphocyte reduction type. Symptoms: clinical manifestations are diverse, mainly determined by pathological type, primary tumor site and affected organ Early or late stages of the disease. The earliest manifestations are that the superficial lymph nodes are painless progressive enlargement, often lack of systemic symptoms, and progress is slow. About 60% of the primary lymph nodes originate in the cervical collar and originate on the collarbone. The axillary and inguinal lymph nodes are less common. At the beginning, the lymph nodes are soft and do not stick to each other, and there is no tenderness. In the later stage, the lymph nodes are fast and can be adhered into a huge mass. It is characterized by no inflammation in adjacent tissues and cannot be used to explain lymph nodes. The cause of swelling. The enlarged lymph nodes can cause local compression symptoms, such as mediastinal lymphadenopathy, which can cause dry cough. Abdominal pain without cause can be caused by enlarged peritoneal lymph nodes. Systemic symptoms may have low fever or characteristic Sexual regression heat type, that is, a few days or weeks after a few days of high fever, Pel-Ebstein fever. There are often loss of appetite, nausea, night sweats and weight loss. The lesions often do not appear. Skin itching is a common symptom in adults, rarely seen in children, and even in the spread of a wide range of organs throughout the body. About a quarter of children have metastasized outside the lymph nodes at the time of diagnosis. Tissue, more common in the spleen, liver, lung or bone and bone marrow. X-ray changes in the lung infiltration are mostly villous exudative changes, difficult to distinguish from fungal infections, more rapid breathing and fever, and even respiratory failure. Liver Involved, symptoms of intrahepatic biliary obstruction, moderate swelling of the liver, yellow staining of the sclera, increased serum direct and indirect bilirubin and alkaline phosphatase, neutrophils, thrombocytopenia and anemia in bone marrow infiltration. Mucosal ulcers and gastrointestinal bleeding can occur. Lymphoma occurs in the epidural space of the spinal cord and can cause compression symptoms. In addition, various immune dysfunctions such as immune hemolysis, thrombocytopenia or nephrotic syndrome can occur. Hodgkin's disease itself, or due to chemotherapy can cause low cellular immune function, such children are prone to secondary infections, about one-third of children with herpes zoster, and can spread to invade lung tissue. Fungal infections such as cryptococcus, corpus corpus, and Candida albicans are also common complications, and the lesions are more extensive. For elderly children with persistent cervical lymphadenopathy, the disease should be suspected, because patients with this age group have a rare cervical lymphadenopathy due to inflammation of the upper respiratory tract. Chronic lymphadenopathy that cannot be found in other areas should also be thought of. The medical history should be detailed and a comprehensive physical examination should be performed. The final diagnosis depends on the pathological examination of the lymph nodes, and the larger lymph nodes should be taken for pathological examination. Puncture and absorption of lymphoid tissue is too unreliable because of too little material. Diagnosis: The disease should be differentiated from chronic suppurative lymphadenitis, lymphatic tuberculosis, infectious mononucleosis, and lymph node metastasis of malignant tumors. Lymph node reactive hyperplasia caused by local chronic inflammation is sometimes difficult to distinguish from this disease. Complications: Bone involvement can cause pain and vertebral osteoblastic lesions ("ivory" vertebrae); rare is osteolytic lesions with compression fractures. The lumps of the intrahepatic and extrahepatic bile ducts can cause jaundice. Pelvis Or inguinal lymphatic obstruction can cause lower extremity edema. Tracheal bronchial compression can cause severe dyspnea and wheezing. Infiltration of lung parenchyma can be similar to lobectomy or bronchial pneumonia, and can cause cavities or lung abscess. Treatment: Chemotherapy or radiotherapy can be cured Most patients. The radiation dose of 4000~4500cGy in 4~4.5 weeks can cure lymphadenopathy in more than 95% of patients. In addition, standard therapy should include 3600cGy irradiation in adjacent uninjured areas (expanded field) because The lesion is spread through the adjacent lymph. Although radiotherapy and chemotherapy are often recommended, patients with subtype E may be effective for radiotherapy. For special cases, the first radiotherapy may be considered without staging, but the treatment plan is mainly based on staging. According to the diseases of stage I and IIA, radiation therapy can be used alone, but the irradiation field of treatment should be expanded, including the area where all lymph nodes are distributed on the sputum, most patients should Large to the aortic lymph nodes and aortic bifurcation and spleen or spleen pedicle. This treatment can cure about 80% of patients. Cure refers to disease-free survival 5 years after treatment, after which recurrence is extremely rare. In patients with mediastinal (>1/3 of the diameter of the thoracic cavity), the recurrence rate of single radiotherapy is high, and post-chemotherapy radiotherapy can prolong the recurrence-free survival of about 75% of patients. For special IA, nodular sclerosis, or lymphocytes For patients with superiority, cloak-type irradiation alone may be sufficient. Stage IIIA1 disease, irradiation of all lymph nodes (cloak type and inverted Y type) can achieve a total survival rate of 85% to 90%, and a 5-year disease-free survival rate can reach 65% to 75%. In some special cases (such as only mild spleen disease), a smaller range of radiation therapy (minus pelvic irradiation field) is also effective. For IIB and IIIA1 diseases, radiotherapy and Chemotherapy, a combination chemotherapy regimen for stage IIIA2 disease, with or without lymph node radiotherapy. The cure rate has reached 75% to 80%. Because radiotherapy alone cannot cure stage IIIB Hodgkin's disease, it needs to be used alone. Combined chemotherapy or combined chemotherapy combined with radiotherapy, the survival rate is 70% to 80%. Stage A and B diseases, using a combination chemotherapy regimen, especially with the MOPP regimen (nitrogen mustard, vincristine, procarbazine, prednisone) or the ABVD regimen (adriamycin, bleomycin, vinblastine, Azadamine. According to recent randomized studies, ABVD has become the standard protocol for the treatment of most Hodgkin's patients. This program has resulted in 70% to 80% of patients with complete remission, and >50% The disease persisted for 10 to 15 years. The results of the prospective study did not prove that the effect of alternating MOPP with ABVD or other drugs combined with the other drugs would be better than the ABVD program. Other effective drugs are nitrosourea, streptozotocin, and Chloramphenicol and etoposide. Patients who fail to relapse or relapse within 6 to 12 months have a poor prognosis. The efficacy of conventional rescue therapy is limited. The transplantation of autologous bone marrow or peripheral blood stem cells can be performed. The treatment of systemic conditions can be tolerated and effective in re-induction chemotherapy, the self-transplant cure rate can reach 50%. Allogeneic transplantation seems to be inferior and therefore not recommended. Self-transplantation has been initiated in patients with high-risk Hodgkin's disease In the study. Prevention: mainly aimed at malignant lymphoma A variety of factors for prevention. It is currently believed that the loss of normal immune surveillance function, the tumorigenic effect of immunosuppressants, the activity of latent viruses and the long-term application of certain physical (such as radiation), chemical (such as anti-epileptic drugs, adrenocortical hormone) substances, Lead to the proliferation of lymphatic network, and eventually malignant lymphoma. Therefore, pay attention to personal and environmental hygiene, avoid drug abuse, and pay attention to personal protection when working in a harmful environment.