Asymptomatic lymphadenopathy

1. Hodgkin's disease Clinical presentation Asymptomatic lymphadenopathy Mediastinal mass Systemic symptoms Fever , Pruritus Other nonspecific symptoms and paraneoplastic syndromes Intra-abdominal disease Cholestatic liver disease Alcohol-induced pain Nephrotic syndrome Skin lesions , Neurologic syndromes

2. HODGKIN”s disease Nodular sclerosis HDMixed cellularity HDLymphocyte depletion HDLymphocyte-rich classical HDNodular lymphocyte predominant HD

5. Staging in hodgkin”s Lymphoma Stage I — Involvement of single lymph node region (I) or of single extralymphatic organ or site (Ie) Stage II — Involvement of two or more lymph node regions on the same side of the diaphragm alone (II) or with involvement of limited, contiguous extralymphatic organ or tissue (IIe) Stage III — Involvement of lymph node regions on both sides of the diaphragm (III) which may include the spleen (IIIs) or limited, contiguous extralymphatic organ or site (IIIe) or both (IIIes) Stage IV — Diffuse or disseminated foci of involvement of one or more extralymphatic organs or tissues, with or without associated lymphatic involvement

8. Poor prognose sign & symptome in HD • B symptoms • ** Clinical stage IIB to IVBBulky diseaseAnemia • Leukopenia • Thrombocytopenia

10. International prognostic score : International Prognostic Factor Project on Advanced Hodgkin's Disease based upon the total number of seven potential unfavorable features at diagnosis: 1-Serum albumin less than 4 g/dL (40 g/L), 2-Hemoglobin less than 10.5 g/dL (105 g/L), 3-Male gender, 4-Age over 45 years, 5-Stage IV, 6-White blood cell count 15,000/microL, 7-Lymphocyte count less than 600/microL and/or less than 8 percent of the white blood cell count . This analysis showed a spread in the event-free survival at five years, as follows: No factors --— 84 % ( 7 % of patients) One factor —-- 77 % (22 % of patients)Two factors — 67 % (29 % of patients) Three factors — 60 % (23 % of patients)Four factors — 51 % (12 % of patients)Five or more factors --42% (7 % of patients)

11. Criteria for B symptoms : B symptoms generally correlate with advanced stage and bulk disease. Specific B symptoms are defined as follows:    1-Unexplained weight loss of more than 10 percent of body weight during the six months before initial staging investigation   2- Unexplained persistent or recurrent fever with temperatures above 38؛C during the previous month 3-Recurrent drenching night sweats during the previous month.

13. Incedence of HD 1- Socioeconomic status and environmental risk factors 2- Infectious agents 3- Clustering 4- Genetic factors 5- ROLE OF EPSTEIN-BARR VIRUS 6- HD and immunosuppression

14. Initial evaluation and diagnosis of Hodgkin's disease HISTORY AND PHYSICAL EXAMINATION TISSUE BIOPSY Bone marrow biopsy LABORATORY STUDIES IMAGING STUDIES: chest, abdomen, liver, spleen, bone. Gastrointestinal tract Central nervous system

15. CLASSICAL HODGKIN'S LYMPHOMA Lymphocyte-rich classical Hodgkin's lymphoma Nodular sclerosis Hodgkin's lymphoma Mixed cellularity Hodgkin's lymphoma Lymphocyte depletion Hodgkin's lymphoma

17. Immunophenotypein HD : The immunophenotype is an important part of the definition of NLPHL. The atypical cells are CD45+ , express B - cell associated antigens ( CD19 , CD20 , CD22 , CD79a ) , and EMA but lack CD15 and CD30.

33. HODGKIN”s disease Nodular sclerosis HDMixed cellularity HDLymphocyte depletion HDLymphocyte-rich classical HDNodular lymphocyte predominant HD

34. . Of NHLWHO classification Indolent — survival of the untreated disease measured in yearsAggressive — survival of the untreated disease measured in monthsHighly aggressive — survival of the untreated disease measured in weeks.

35. . Of NHLWHO classification Indolent — survival of the untreated disease measured in yearsAggressive — survival of the untreated disease measured in monthsHighly aggressive — survival of the untreated disease measured in weeks.