Hodgkin's disease - Chronic
Rahul Soman, M. Pharm
Definition
A discrete lymphomatous malignancy, histologically characterized by Reed-Sternberg cells in an appropriate cellular milieu
Medical History
* Past medical history of Epstein-Barr virus infection
* HIV positive
* Family history of Hodgkin's disease
* Genetic predisposition
* Socioeconomic History
Findings
* Chest pain
* Dysphagia - Chronic
* Splenomegaly
* Asthenia
* Fatigue
* Fever
* Lymphadenopathy
* Malaise
* Night sweats
* Pruritus
* Weight loss
* Bone pain
* Cough
* Dyspnea - Chronic
* Rash
Tests
Suspected and known lymphoma
* Complete blood count with white cell differential, manual: A CBC with differential is sometimes helpful in the diagnosis of lymphoma and in ruling out non-lymphomatous causes of lymphadenopathy, although normal results do not rule out disease.
Suspected and known Hodgkin disease
* Erythrocyte sedimentation rate, automated
* Plain chest X-ray
* Computerized axial tomography
Lymphoma
* Plasma lactate dehydrogenase measurement: Lactic dehydrogenase (LDH) is a useful test for assessing risk and monitoring progress in lymphomatous disease .
Suspected and known lymphoma
* Excision of lymph node: If malignancy is strongly considered, a lymph node biopsy is indicated and consultation with a hematologist/oncologist sought immediately.
Hodgkin disease and non-Hodgkin lymphoma
* Bone marrow biopsy, needle or trocar: Bone marrow aspiration and biopsy may be recommended in select cases of lymphoma for evaluation, diagnosis, or staging .
Differential Diagnosis
* Hodgkin's disease, nodular sclerosis
* Hodgkin's disease, mixed cellularity (clinical)
* Hodgkin's disease, lymphocytic depletion (clinical)
* Hodgkin lymphoma, lymphocyte-rich (clinical)
* Hodgkin's disease, lymphocytic predominance - nodular
* Non-Hodgkin's lymphoma - Chronic
* Pharyngitis - Acute
* Epstein-Barr virus infection
* Cytomegalovirus infection - Acute
* Toxoplasmosis - Acute
* Cat scratch disease - Acute
* Herpesvirus infection
* Sarcoidosis - Chronic
* Brucellosis - Acute
* Acute lymphoid leukemia - Acute
* Tuberculosis - Chronic
* Neoplasm of head and neck
* Lung cancer
* Breast cancer - Chronic
* Malignant tumor of thyroid gland - Chronic
Treatment
Drug Therapy
Hodgkin disease
DOXORUBICIN HYDROCHLORIDE - BLEOMYCIN SULFATE - VINBLASTINE SULFATE - DACARBAZINE
MECHLORETHAMINE HYDROCHLORIDE - DOXORUBICIN HYDROCHLORIDE - ETOPOSIDE - VINCRISTINE SULFATE - VINBLASTINE SULFATE - BLEOMYCIN SULFATE - PREDNISONE
BLEOMYCIN SULFATE - ETOPOSIDE - DOXORUBICIN HYDROCHLORIDE - CYCLOPHOSPHAMIDE - VINCRISTINE SULFATE - PROCARBAZINE HYDROCHLORIDE - PREDNISONE
RITUXIMAB
Procedural Therapy
Hodgkin disease
* Radiation therapy: Radiotherapy may be used in all stages of Hodgkin disease but emphasis is on combined modality treatment with limited irradiation .
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