Hodgkin’s Disease

Epidemiology

  • No clear association with HIV

Physiology

  • Contiguous spread to lung parenchyma
  • Orderly contiguous spread from mediastinal (involved in 66% of Hodgkin’s cases) nodes -> hilar nodes -> lung parenchyma (involved in >10% of cases: almost always associated with mediastinal node involvement)
  • Bulky mediastinal disease (tumor: thoracic diameter ratio >0.3): associated with spread to pleura/ pericardium/ chest wall (spread probably requires bulky mediastinal nodes)

Pathology

  • Nodular sclerosing type is present in 67-84% of cases with thoracic Hodgkin’

Diagnosis

  • Sputum cyto: may reveal Reed-Sternberg cells
  • FOB: may reveal Reed-Sternberg cells by BAL/ EBB/ TBB
  • FNA: cyto is useful to diagnose lung lesions in most cases
  • OLB: may be necessary
  • CXR/Chest CT Pattern:
    • Mediastinal adenopathy: present in almost all cases with parenchymal lung involvement
    • Linear interstitial infiltrates and/ or small nodules: due to contiguous spread to lung

Clinical

  • B symptoms: fever/ night sweats/ weight loss
  • Lesions near airway: obstructive symptoms

Treatment

  • Treatment is stage dependent
  • Bulky mediastinal disease: chemo or chemo + XRT
  • Nodular/interstitial lung involvement: need to treat with chemo or XRT involving affected lung area
  • Complications of treatment: NHL, sarcoma, lung ca. occurring in irradiated field (may occur years later)
  • Post-treatment recurrence (to lungs): predisposed by advanced stage disease at diagnosis (especially with B symptoms)/ bulky mediastinal nodes/ inadequate initial staging or treatment
    • For XRT-treated cases: recurrence occurs at edge of mantle field of XRT or diffusely in lungs
    • For chemo-treated cases: recurrence at prior nodal sites (especially bulky mediastinal nodes) or extension into lung

Prognosis

  • Controversial if lung involvement portends worse prognosis

References

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