HY lecture notes:
16F + painless lateral neck mass + mediastinal mass; Dx? –> Hodgkin lymphoma
16F + painless lateral neck mass + hepatomegaly; Dx? –> Hodgkin lymphoma
Above two presentations are HY. Not hard, but if you haven’t heard them clearly stated, you might be like hmm wtf is the diagnosis here.
The mediastinal mass is not a thymic lesion; it’s mediastinal lymphadenopathy.
Hodgkin will be B cell origin.
Reed-Sternberg cells (“Owl-eye” on histo; [unrelated, but CMV-infected cells also carry this description]). RS cells have CD15 + CD30 positivity.
Different types of Hodgkin:
Nodular sclerosing = type most frequently seen in women.
Lymphocyte-rich = high ratio of lymphocytes to RS cells (i.e., fewer RS cells).
Lymphocyte-deplete = low ratio of lymphocytes to RS cells (i.e., more RS cells).
More RS cells = worse prognosis. So lymphocyte-deplete = worse prognosis.
Many regimens to Tx. But “ABVD” is classic and HY = Adriamycin (doxorubicin); Bleomycin, Vinblastine, Dacarbazine.
Adriamycin causes dilated cardiomyopathy –> enlarged cardiac silhouette + pulmonary edema (diffuse infiltrates or “bat wings” on CXR)
Bleomycin causes pulmonary fibrosis –> reticulonodular / reticular pattern (honey-combing) on CXR.
Don’t confuse vinblastine (bone marrow toxic –> neutropenia –> mouth ulcers + fever) with vincristine (neurotoxic).
Dacarbazine is an alkylating agent (you won’t get asked on it).
Hodgkin can lead to minimal change disease. This one’s always a weird one for students:
40M + Hodgkin + renal issue + no blood in the urine; renal Dx? –> answer = minimal change disease. Student says “wtf? That’s peds though.” Yeah, but it’s also Hodgkin. Due to a cytokine effect at the glomerulus. You learn something new every day.
32-year-old African-American woman + dry cough + nodular densities on CXR (bihilar lymphadenopathy); answer = sarcoidosis = “non-caseating granulomas.”
32-year-old African-American woman + dry cough + no changes on CXR; answer = asthma = “activation of mast cells.”
