Hodgkins Lymphoma

HISTORY

• First noticed the swelling 6mts ago insidious in onset, about 1cm in diameter gradually increased to attain the present size. History of localised pain since five months and is dull aching.
• History A 56 yrs old female patient by name Smt. Devaki presented to Dept. of Surgery complaining of swelling and pain in left Supraclavicular region from past 6mts.

Patient of irregular of fever present. She has no complaints in the breast upper limb or abdomen.

• Past medical history revealed she had undergone hysterectomy five months back and biopsy of present lesion. The report was inconclusive.
• Family and personal history nothing significant.
• General Physical examination revealed no abnormalities.

EXAMINATION

• On inspection a swelling in left supraclavicular region about 10×8 cm in diameter, nodular, surface shows scar of previous biopsy.
• On palpation multiple swellings discrete, tender, mobile and firm in consistency.

Examination of Thyroid, breast, upper limb, and abdomen revealed no lesion.

INVESTIGATION

• Routine blood and urine examination-the values with in the normal limits.
• PA Chest and ultrasonography reveals no primary.
• Excisional biopsy.

PROVISIONAL DIAGNOSIS

• Hodgkins Lympoma

Differential Diagnosis:

• Tubercular lymphadenitis
• Secondary?

COMPARISON OF HODGKIN’S AND NON-HODGKIN’S LYMPHOMA

	Hodgkin’s Lymphoma	Non-Hodgkin’s lymphoma
Age	Bimodal Age	More than 50 years
Involvement of lymph nodes	Left supraclavicular, axillary	External Waldayer’s ring, submental, submandibular, preauricular, postauricular, occipital nodes.
Tonsil enlargement	Not enlarged	Tonsils may be enlarged
Epitrochlear node	Not enlarged	Can be enlarged
Hepatomegaly	Uncommon	Common in low grade
Involvement of bone	Uncommon (10%)	In 40% of cases, iliac crest is involved by the of diagnosis
Alcohol induced pain	Characteristic	Absent
Fluctuating fever	Present	Absent
Prognosis	Better prognosis	Poor prognosis

Clinical staging of lymphoma:

• Stage I: Lymph node involvement in one anatomical region or involvement of single extralymphatic organ or site (I.E).
• Stage II: Involvement of two or more anatomical group of lymph nodes confined to same side of diaphragm.
• Stage III: Involvement of the lymph nodes on both sides of the diaphragm, with or without spleen.
• Stage IV: Diffuse involvement of one or more extra-lymphoid organs with or without lymph nodes involvement. Liver (H), marrow (M), pleura (P), bones (O), etc.

Each stage is further divided into group A which means absence of symptoms and group B means presence of symptoms.
The symptoms are :

• Fever, above 38°C or night sweats.
• Pruritus, may be the presenting feature of nodular sclerosis.
• Weight loss more than 10% of body weight in the last 6 months.
• Bony pains.
• Anemia.