Pathology Spotlight – Hodgkin’s Lymphoma

Lymphoma occurs when there is an overgrowth of cells in the lymph glands, enlarging them, predominantly in the armpits, chest, neck and groin.  In Hodgkin lymphoma (HL), the cells which begin to grow out of control are derived from B-lymphocytes -a type of white blood cell.

The specimen below, was derived from a patient who presented with a swelling in the left side of the neck, which increased in size over six months. The specimen shows the front of the neck, lower jaw with teeth and the tongue. Under the chin and on the right side of the specimen, huge lymph nodes are evident which must have been stretching the skin such that they must have been almost touching the ear. According to the contemporary notes these huge nodes had ‘..displaced the trachea and oesophagus to the (patient’s) right. .’ i.e. the left viewing the specimen from the front. Other large nodes, about the size of golf balls, can be seen in the neck.

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Lymphoma cells can sometimes spread through the lymphatic system and reach the bloodstream, which may carry them to other organs where they may form a new tumour.  The Hodgkin/Reed Sternberg cell is the characteristic cell found in HL and is seen as the large distinctive cell with 2 nuclei in the middle of the photomicrograph below (image courtesy of Creative Commons). Today HL is not treated by operation but by chemotherapy or radiotherapy, alone or in combination, and sometimes combined with steroids. Occasionally after high dose treatment to clear the bone marrow of disease, a stem cell transplant or marrow transplant is required.

hodgkin-microscope

Lymphoma is the most common blood cancer and is currently the fifth most common cancer diagnosed by clinicians in the UK (after breast, lung, colon and prostate cancers).  In 2011 there were 2,047 patients with HL in Scotland a prevalence of 0.039% of the population.  Around 1 in 10 cancers diagnosed in children are lymphomas. HL is more common in males, in younger age groups and after a viral infection such as infectious mononucleosis and in those with a family history. Any new swelling in neck, armpit or groin should be checked out by a doctor.

This week is Lymphatic Cancer Awareness Week, and you can find out more about Lymphoma herelcaw

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