Today, Mbah Dukun Bagong, Indonesian Modern Shaman from Medical and Health Information, posts about malignancy of Lymphatic system, follow up of non-hodgkin lymphoma. Lets we learn Hodgkin's Lymphoma together.
4. Clinical Manfestations
6. How to Diagnose
7. Treatment and Therapy
Hodgkin's lymphoma is a limphareticular system malignancy and its supporting tissues that often attacks the lymph nodes and accompanied by the typical histopathological picture. Histopathologic characteristics are considered typical is the presence of Reed cells - Steinberg or its variants are called Hodgkin cells and pleimorfik lymph nodes picture.
Classification of Hodgkin's lymphoma
Hodgkin's lymphoma classification.
• Lymphocyte-predominant (LP)
• Mixed cellularity (MC)
• lymphocyte-depletion (LD)
• -nodular sclerosis (NS)
Parameters subtype identity more in quantity datia Reed-Steinberg cells, lymphocytes and connective tissue reaction
|Lymphocyte predominant type|
1. Lymphocyte predominant type
In this type, the lymph nodes primarily composed of mature lymphocytes, some Reed-Sternberg cells. Usually found in children and the prognosis is good.
|Mixed cellularity Type|
Having pleimorfik pathological picture with plasma cells, eosinophils,
neutrophils, lymphocytes and many Reed-Sternberg cells obtained. and is extensive disease and the extranodule organ. Often accompanied by systemic symptoms such as fever, weight loss and sweating. prognosis is more worse.
Similar pathological picture are diffuse histiocytic lymphoma, Reed-Sternberg cells much once and there are few other types of cells. Normally in the elderly and tend to is an extensive process (aggressive) with systemic symptoms. Poor prognosis.
|Nodular Sclerosis Type|
Gland contains nodules that are separated by collagen fibers. Often Reed-Sternberg cells was reported that atifik called Hodgkin cells. Often obtained in young women / teens. Mediastinal glands are often attacked.
Much progress has been achieved in the field biology of this disease. Although there are still many that have not been established. As in other malignancies, the cause of Hodgkin's disease is multifactorial and not yet completely clear.
Genetic changes, dysregulation of growth factor genes, viral and immunological effects, can all tumourigenic factor for this disease.
About the origin of Reed-Sternberg cells datia there is still disagreement as to the present. Contaminated or aggressive non-Hodgkin's lymphoma Hodgkin's probably something to do with family. When one family member suffering from Hodgkin's lymphoma, the risk of contracting other members of the tumor is larger than with anyone else that does not include the family. In people live in groups the incidence of Hodgkin's lymphoma more likely.
CLINICAL FEATURES (symptomatology)
Hodgkin's disease usually occurs as a local disease and then spread to lymphoid structures nearby and eventually expanded into non-lymphoid tissues with the possible death of the patient. Hodgkin's disease patients generally come with a mass or group of lymph nodes are solid, easily moved and are usually non-tender. Approximately half of patients present with adenopathy in the neck or supraclavicular area and more than 70 percent of patients present with superficial lymph node enlargement. Because generally painless, so the detection by the patient may be delayed until the lymph nodes is large enough.
About 60 percent of patients present with mediastinal adenopathy. It is sometimes first detected on examination of routine chest x-ray. Affected lymph nodes in Hodgkin's disease tends to centripetal or axial and different to those affected in non-Hodgkin's lymphoma showing the centrifugal tendencies of the lymph nodes epitroklear, rings waldeyer and abdomen.
The majority of patients with Hodgkin's disease have little or no symptoms related to disease. Common symptoms are mild fever that may be accompanied by night sweats. For most patients, night sweats may be the only complaint. Some patients may experience fever up and down with lots of night sweats (Pel-Epstein fever). Fever may persist for several weeks, followed by afebrile intervals. Fever and night sweats more often found in older patients and in patients with advanced-stage disease.
Another important early symptoms, weight loss is more than 10 percent in 6 months or less for no apparent reason. Other symptoms that are often found is a sense of weakness, malaise and fatigue quickly. Pruritus was found in about 10 percent of patients at diagnosis, symptoms are usually generalized and may be associated with skin rashes or even rarely the only symptom of the disease.
Mediastinal abnormalities, lung, pleura or pericardium may be accompanied by cough, chest pain, shortness of breath or osteoartropi hypertrophic, bone involvement may be accompanied by bone pain.
In some patients present with symptoms kadng superior vena cava obstruction as an initial symptom. Sudden spinal cord compression can be an early symptom but is usually a progressive disease with advanced complications. Headaches or visual disturbances may be found in patients with intracranial Hodgkin's disease and involvement of abdominal cause abdominal pain, intestinal disorders and even ascites
STADIUMS/STAGES of HODGKIN LYMPHOMA
In this disease distinguished two kinds of staging:
Clinical staging •
Clinical staging is done only on the presence or absence of organ abnormalities.
Pathological staging. •
Staging is also supported by histopathological abnormalities in the abnormal tissue. Pathological staging is expressed also on organ biopsy results, which are: liver, lung, bone marrow, lymph, spleen, pleura, bone, skin.
Staging adopted today are staging according to Ann Arbor that the appropriate modifications Cotswald conference.
Stage I: The disease affects one lymph node region or a lymphoid structure (eg: spleen, thymus, Waldeyer ring).
Stage II: The disease attacks the glands of two or more regions on one side of the diaphragm, the amount of which attacked the region represented by subscript numbers, eg: II2, II3, and so on.
Stage III: The disease attacks the region or lymphoid structure above and below the diaphragm.
III1: attack the gland splenikus hiler, seliakal, and portals
III2: attack the para-aortal glands, mesenterial and iliakal.
Stage IV: The disease attacks the organs of extra nodules, except those belonging to E (E: if the primary attack one extra-nodal organs).
A: if no symptoms of systemic
B: when accompanied by systemic symptoms are: fever ≥ 38 ˚ C is not clear why; 10% weight loss or night sweats or any combination of three symptoms that last for 6 months this disease.
X: if there is bulky mass (≥ 1 / 3 the width of the thorax and ≥ 10 cm for the size of the gland).
S: if the spleen (spleen) is affected.
To determine the extent of disease, staging procedures required certain
Procedures required to determine the level (stage) Hodgkin's disease
I. History and examination:
Identification of systemic symptoms
II. Radiological procedures:
• regular chest Photo
• CT scan of the chest (if the photos of abnormal chest)
• CT scan of abdomen and pelvis
• bipedal lymphography
III. Haematological procedures:
• complete blood counts
• bone marrow aspiration and biopsy
IV. biochemical procedures
• physiology liver Test
• Serum albumin, LDH, Ca
V. Procedures for specific things:
• laparotomy (diagnostic and staging)
• Abdominal ultrasound
• Gallium scanning
• Technetium bone scan
• the liver and spleen scan