Introduction to Hodgkin's disease

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. The origin of the cervical lymph nodes is more common, gradually spread to adjacent lymph nodes, and then invade the spleen, liver, bone marrow and lungs and other tissues. 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. Etiology: The lymph nodes of the lesion are enlarged, the normal structure is destroyed, and some or all of them are replaced by tumor tissue. Microscopically, lymph nodes are infiltrated, such as granuloma. Among them, mononuclear or multi-core Sternberg-Reed cells, lymphocytes, eosinophils and plasma cells are infiltrated, and fibrous tissue can be formed. Finding Si-Rui cells is the basis for diagnosing this disease. In recent years, it has been found that different pathological changes have a great relationship with prognosis. In order to adopt different effective treatments, further classification is necessary. At present, Rye classification is adopted internationally and domestically, and it is divided into four types according to the prognosis. 1, lymphocyte dominant type is the best type of differentiation, can also be considered as the early stage of Hodgkin's disease, its degree of malignancy is relatively low, the lesion is often limited to one or a group of lymph nodes. The clinical symptoms are very mild or have no discomfort. Microscopically, lymphocytes and histiocytes showed different proportions of hyperplasia in the area where the normal lymphoid tissue disappeared, and the small lymphocyte proliferation was common; Si-Rui cells were rare and atypical. There is no necrotic change in the lymph nodes. This lymph node is the most difficult to distinguish from inflammatory lesions and is easily missed. This type accounts for about 10% to 20% of the disease and has the best prognosis. 2, nodular hardening type This type rarely evolved into other types. Occurs in the mediastinal lymph nodes, but also can affect the supraclavicular lymph nodes, rarely seen in the abdominal lymph nodes, clinical development is slow. There are more collagen fiber bundles in the lesion that divide the tumor cells into individual nodules. Si-Rui cells are commonly found in fissure-like blanks, also known as lacunar cells, which are the most common type in childhood, accounting for about half of the disease, and the prognosis is second only to lymphocyte dominant. 3, mixed type can be derived from the dominant type of lymphocytes. Most of the clinical symptoms have obvious symptoms. The structure of the lymph nodes disappears diffusely, but only a part of the structure is destroyed when the lymph nodes are initially involved. There are various cells in the lesion including lymphocytes, histiocytes, eosinophils and plasma cells, and there are typical binuclear and lobulated nuclei. Or multi-nuclear S-Rui cells with larger nucleoli. This type varies widely, and is typically easy to diagnose. Atypical is confused with inflammatory granuloma, tuberculosis, and reactive hyperplasia. This type accounts for more than 10% of the disease. There are many extranodal lymph nodes in the diagnosis, and the prognosis is poor. 4, lymphocyte reduction type can be directly evolved by lymphocyte dominant type, or converted from mixed type, is the late stage of lymphoma, is the worst type of differentiation, and the disease develops rapidly. There are few lymphocytes in the lesion, which can be divided into two forms, a diffuse sclerosis composed of transparent collagen fibers, lymphocytes are significantly rare, and the lymph node volume can be reduced. One is mainly composed of a large number of heterogeneous reticulocytes. - Wright cells are easy to find. This type accounts for about 10% and has the worst prognosis. In children, there are more nodular sclerosis and lymphocyte predominance, which is the reason for the long survival period of Hodgkin's disease in children. Staging is helpful in judging the prognosis and the choice of treatment options. Stage I lesions are limited to one lymph node, or one anatomical region of the lymph node (I), or only one extranodal tissue has lesions (IE). Stage II lesions are confined to two or more lymph nodes adjacent to the anatomical region, or two non-adjacent lymph nodes (II) on the ipsilateral side, or one side of the lymph nodes or the same side or several Lymph nodes have lesions (IIE). Stage III lesions are on both sides of the transverse iliac crest (III), or at the same time invading the extranodal tissue (IIIE), with spleen invasion (IIIS) or both (IIIES). Stage IV lesions extensively invade lymph node tissues, such as bone marrow, liver, lung, pleura, bone, skin, kidney, gastrointestinal tract, etc. with or without lymphadenopathy. Each of the above issues is divided into two groups, A and B. Patients in group A had no systemic symptoms, and patients in group B had fever, night sweats, and no more than 10% weight loss within six months. Symptoms: The clinical manifestations vary widely, mainly due to pathological classification, the location of the primary tumor and the affected organs, and the early or late stages of the disease. The earliest manifestations were that the superficial lymph nodes showed painless progressive enlargement, often lacking systemic symptoms, and progressed slowly. About 60% of the origin is in the cervical lymph nodes, which are less common in the supraclavicular, infraorbital and inguinal lymph nodes. At the beginning, the lymph nodes are soft and do not stick to each other, and there is no tenderness. It grows rapidly in the later stage and can stick to a huge mass. It is characterized by no inflammation in adjacent tissues and cannot be used to explain the cause of lymphadenopathy. A swollen lymph node can cause local compression symptoms, such as mediastinal lymphadenopathy that compresses the tracheobronchial, causing a dry cough. Abdominal pain without cause can be caused by enlarged peritoneal lymph nodes. Systemic symptoms can have low fever, or a characteristic regression heat type, which can be a few days or weeks of Pel-Ebstein fever after a few days of high fever. There are often loss of appetite, nausea, night sweats and weight loss. These symptoms often do not occur when the lesion is limited. Itchy skin is a common symptom in adults. It is rare in children and does not occur even when a wide range of organs are invaded. About a quarter of children have metastasized to tissues other than lymph nodes at the time of diagnosis, and are more common in the spleen, liver, lung or bone and bone marrow. X-ray changes in the lung infiltration are mostly villous exudative changes, which are indistinguishable from fungal infections, with more rapid breathing and fever, and even respiratory failure. Liver involvement, intrahepatic biliary obstruction symptoms, moderate liver enlargement, scleral yellow staining, serum direct and indirect bilirubin and alkaline phosphatase increased. Bone marrow infiltration results in neutrophils, thrombocytopenia, and anemia. Mucosal ulcers and gastrointestinal bleeding can occur in the digestive tract. 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 may occur. He Jiejin disease itself, or due to chemotherapy can cause low cellular immune function, such children are prone to secondary infections, about one-third of the children with herpes zoster, and can spread the lung tissue. Fungal infections such as cryptococcus, corpus corpus, and Candida albicans are also common complications, and the lesions are more extensive. Diagnosis: 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 upper respiratory tract inflammation. 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. After the diagnosis, the stage should be further staged. Since many patients have only one group of cervical lymphadenopathy after general examination, the diagnosis is stage I, but there is often a mediastinal or abdominal cavity metastasis. Therefore, only about one-third of the clinical examinations are inaccurate. Therefore, the following checks should be made. (1) X-ray tomography of the chest and mediastinum: hilar lymphadenopathy and pulmonary infiltration can be found. (2) inferior vena cava angiography and intravenous pyelography: the former can be found in the second lumbar vertebrae above the aortic lymph nodes, the latter can show whether the ureter is displaced, in addition to the service department radiotherapy needs to understand the location of the kidney. (3) Pediatric lymphography: early detection of abdominal and aortic lymphadenopathy. (4) Skeleton X-ray film to understand whether the bone is invaded. (5) Determination of serum alkaline phosphatase: If the increase indicates the possibility of bone and liver metastasis. (6) It is necessary to do liver and spleen scanning and liver function measurement: Ultrasound scan (B ultrasound scan) is very helpful for finding abdominal cavity lesions. If there is a high degree of suspicion that the abdominal lymph nodes have lesions, laparotomy can be performed, and spleen resection should be performed. The abdominal and posterior abdominal lymph nodes and liver tissues should be taken for pathological biopsy. Identification of this disease must 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: Swollen lymph nodes can cause local compression symptoms, such as mediastinal lymphadenopathy, compression of the tracheobronchial, causing dry cough. X-ray changes in the lung infiltration are mostly villous exudative changes, which are indistinguishable from fungal infections, with more rapid breathing and fever, and even respiratory failure. Liver involvement, intrahepatic biliary obstruction symptoms, moderate liver enlargement, scleral yellow staining, serum direct and indirect bilirubin and alkaline phosphatase increased. Bone marrow infiltration results in neutrophils, thrombocytopenia, and anemia. Mucosal ulcers and gastrointestinal bleeding can occur in the digestive tract. 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 may occur. Treatment: Western medicine treatment In recent years, due to the combination of pathological typing, clinical staging and radiotherapy, chemotherapy, surgery and other treatments, the efficacy has been significantly improved. Early diagnosis and treatment may be cured. According to the principles of treatment proposed by Kaplan et al, the treatment can be as follows in five stages. Read more...