Hodgkin lymphoma

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Hodgkin lymphoma

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USMLE® Step 1 style questions USMLE

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A 22-year-old woman comes to her physician due to weight loss and fatigue for two months. The patient reports night sweats and high fevers, stating that she has been “soaking the bed sheets through” at night. The patient has no significant past medical history. Vital signs are within normal limits. Physical examination reveals nontender cervical and axillary lymphadenopathy. Which of the following clinical features favors a diagnosis of Hodgkin lymphoma over non-Hodgkin lymphoma?  

External References

First Aid

2024

2023

2022

2021

Epstein-Barr virus (EBV) p. 162

Hodgkin lymphoma p. 434

Hodgkin lymphoma

bleomycin for p. 447

non-Hodgkin vs p. 434

oncogenic microbes and p. 222

paraneoplastic cerebellar degeneration and p. 219

types of p. 733

vinca alkaloids for p. 445

Nodular sclerosing Hodgkin lymphoma p. 733

Non-Hodgkin lymphoma p. 434, 435

Hodgkin lymphoma vs p. 434

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The term Hodgkin lymphoma -can be broken down. Lymph- refers to lymphocytes and oma- refers to a tumor.

So, Hodgkin lymphoma is a tumor derived from lymphocytes - specifically B-cells which mainly reside in lymph nodes.

In case you’re wondering, the disease gets its name from the English physician Thomas Hodgkin, who first described these tumors.

B-cell development begins in the bone marrow, which is a primary lymphoid organ.

That’s where young precursor B-cells mature into naive B-cells.

The naive B cells then leave the bone marrow and circulate in the blood and eventually settle down in lymph nodes.

Humans have hundreds of lymph nodes, scattered throughout the body, and they’re considered secondary lymphoid organs.

Each lymph node has B-cells which group together in follicles in the cortex or outer part of the lymph node, along with T-cells in the paracortex just below the cortex.

B-cells differentiate into plasma cells, which are found in the medulla or center of the lymph nodes.

Plasma cells release antibodies or immunoglobulins.

Antibodies bind to pathogens like viruses and bacteria, to help destroy or remove them.

Various immune cells, including B-cells have surface proteins or markers that are called CD, short for cluster of differentiation, along with a number - like CD19 or CD21.

In fact, the combination of surface proteins that are on an immune cell works a bit like an ID card.

Now, a B cell is activated when it encounters an antigen that binds just perfectly to its surface immunoglobulin.

Some of these activated B-cells mature directly into plasma cells and produce IgM antibodies.

Other activated B-cells go to the center of a primary follicle in the lymph node and they differentiate into B-cells called centroblasts and start to quickly proliferate or divide.

These proliferating centroblasts form a germinal center, located in the center of the follicle of the lymph node.

These centroblasts have a rearrangement of their immunoglobulin genes, and some of them undergo a class switch where they change from producing IgM antibodies to producing IgG or IgA antibodies.

Within the germinal center, centroblasts mature into centrocytes; and the centrocytes that make antibody with high affinity for the antigen, differentiate into either plasma cells which go to the medulla, or memory B-cells which circulate in the blood and reside in lymph nodes, spleen, and mucosa-associated lymphoid tissue, also called MALT.

Summary

Hodgkin lymphoma is a cancer of the lymphatic system typically arising from B-cells. It is commonly seen in immunodeficient individuals, such as those with HIV, and is usually associated with the Epstein-Barr virus. Symptoms may include fever, night sweats, weight loss, and painless and swollen cervical lymph nodes.

Sources

  1. "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
  2. "CURRENT Medical Diagnosis and Treatment 2020" McGraw-Hill Education / Medical (2019)
  3. "Yen & Jaffe's Reproductive Endocrinology" Saunders W.B. (2018)
  4. "Bates' Guide to Physical Examination and History Taking" LWW (2016)
  5. "Robbins Basic Pathology" Elsevier (2017)
  6. "On the origin of giant cells in Hodgkin lymphoma" Communicative & Integrative Biology (2014)
  7. "Primary multifocal osseous Hodgkin's lymphoma" World Journal of Surgical Oncology (2008)
  8. "Hodgkin Lymphoma: Diagnosis and Treatment" Mayo Clinic Proceedings (2015)
  9. "Long-term endocrine side effects of childhood Hodgkin's lymphoma treatment: a review" Human Reproduction Update (2011)
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