Hodgkin's disease

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A 40 yr old Chinese woman complained of painless swellings on both sides of her neck with fever, night sweats and marked loss of weight over the last 1 month.  Physical examination revealed no pallor, jaundice or skin haemorrhages.  She had bilateral cervical, axillary and inguinal lymphadenopathy but no hepatosplenomegaly.

1.    What is the differential diagnosis?

Differentials include:

-     Primary lymph node disorders

-     Metastasis carcinoma

-     Reactive hyperplasia

-     Inflammation / infections

-     Lipid storage diseases

-     Endocrine diseases � hyperthyroidism

2.    What lymph node would you biopsy?

             Cervical, axillary, inguinal, for staging purposes which are crucial for prognosis and treatment.

3.    What other biopsies are indicated?

Spleen, liver, bone marrow

4.    What are the characteristic histopathological features?

Reed Sternberg cells (large, binucleated, bilobed) against a background of non-malignant lymphocytes 

Complete loss of lymph node architecture

5.    What pathology parameters influence the prognosis and treatment of this disease?

Staging, histological subtypes

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Copyright � Joseph Ong 2003