Hodgkin's Disease

What is Hodgkin's Disease

Lymphoid tissue lymphomas, Hodgkin's disease in the group increasingly characterized by enlargement and lymphadenopathy. Malignant lymphomas close resemblance to each other over a third of lymphomas include gösterirler.Hodgkin disease. 20-40 years of age the disease most görülür.Yılda 2/100.000 death ratio is.
Hodgkin's disease, the cause is unknown. Neoplastic in origin, however, is considered more likely.

Pathology

Lymph nodes are not given initially, the disease is spread around and proceed is combined with a specific shape. Lymph nodes are not hard too many times. However, the rapidly growing connective tissue and glands of enfıltre gerginleşir and solidify. Known appearance of the giant Reed-Sternberg cells of Hodgkin's reticular origin. The normal structure of the capsule of the gland was destroyed and the disease has been enfıltre. So many times, and increased fibrous tissue necrosis developed.

Decreases, and Reed-Sternberg cells in lymphocyte develop widespread fibrosis increases. In the cases of nodular sclerosis cases of lymphocytes and the average survival time, less lymphocytes in the cases and cases of diffuse fibrosis is longer.

Clinical symptoms

For the first time in an area (usually cervical) lymph gland, months or years and then monitored adenopathy in other regions. After spreading to other regions before the regions are adjacent. Supraclavicular, axillary, inguinal, brachial or femoral gland growth is monitored. Mediastinal gland enlargement is common. Hodge-hatred in the majority of patients with intrathoracic spread monitored. Parenkimasında other lung infiltration in mediastinal lymph nodes, metastatic-like nodules develop. The main symptoms of expansion of intrathoracic cough, dyspnea, stridor, pain, superior vena cava, especially syanoz and swallowing difficulties due to infiltration.
In most cases there is splenomegaly. Hepatomegaly is common.

The main symptoms of systemic disease with fever, chills, loss of appetite, fatigue, weight loss and night smells his sweat. Fire as a moderate increase at 40 ° C or more. Fire intizamsız or may be at the same level. In some cases, different time periods of fever, followed by periods of fever (Pel-Ebstein type fire). Hodgkin's disease, especially pulmonary and retroperitoneal fire very boring. Anemia develops in the later stages of the disease. And weakness, dyspnea and solukluğa causes an increase in symptoms. Infections are frequent and serious. Tuberculosis Hodgkin'i follows like a shadow.

After drinking alcohol, especially in the area of patients with Hodgkin's disease (eg, mediastinum, or bone) is an interesting finding in the development of a pain. This pain can also occur, and 30-60 minutes of taking a small amount of alcohol is served. Hodgkin's disease were treated with X-ray is taken to control the pain disappears içilmesiyle alcohol.

Radiological findings

Hodgkin's disease in 90% of intrathoracic spread sooner or later that is the importance of chest radiographic examination. Intrathoracic Hodgkin's, so once the expansion begins with mediastinal ganglia. Mediastinal lymph nodes in 50% of cases can be viewed at the beginning of the disease have grown. So many times, this growth of bilateral, but asymmetric nature. Para-tracheal bifurcation glands and a higher incidence of bronchopulmonary disease in some cases even up to glands are participating. Anterior mediastinum and retrosternal adenopatisi may be quite common, and sternal enfıltre. This is very visible spread sarcoidosis. Hodgkin'de posterior mediastinal adenopathy is a rare finding. The disease spread to organs komşa esophagus, superior vena cava and may be infiltrated perikard'a.

Lung expansion is usually associated with mediastinal adenopathy. Nature of local and more coarse reticulonodular radiographic changes observed. In some cases, covers an area of invasion of lung lesion, mediastinal gland. Intensive air bronchogram seen. Parankimasının lung lesions may be cavity. These are single or multiple cavities. Radiography of tuberculosis cavities show a different character, but it is many times lower lobes.

Diagnosis and differential diagnosis

Chest radiography and computer tomography in diagnosis has an important place in particular. Histopathologic examination of lymph node biopsy provides definitive diagnosis. Microscopic examination of the early period of the disease may not be summative. For this reason, the biggest one of them if you have more lymph nodes should be biopsied. Greater chance of being older than the older glands. Reed-Sternberg cells of Hodgkin's diagnosis görülmemişse questionable. In some cases, with an interval of several months for the diagnosis of the disease may have two or three biopsy.
Hodgkin's disease, signs of blood in different nature. WBC count decreased, may be normal or increased. So many times, a moderate leukocytosis observed. If done by increasing the separation of leukocyte granulocytes, lymphocytes and mono-tions were reduced tends to increase. 20% of cases, cases for there is eosinophilia. Normochromic anemia is a common finding. Erythrocyte sedimentation rate is usually accelerated. If you have impaired liver function, hepatomegaly than once. If you have increases in serum alkaline phosphatase of bone lesions. Pleural or peritoneal fluid transudate or exudate of type. Central nervous system symptoms of the disease is monitored or received block are interested punction spinal fluid protein increased, and pleositosiz (cell increase) are available.

Hodgkin's disease develop immune abnormalities, for example, there are some cases leukopenia, serum gamma-globulin and the antibody is reduced. And a significant number of patients, for example, tuberculin skin reactions in the late sensitvite reaction is reduced or negative.

The main reasons for example, tumors that enlarge the lymph glands, infeksi-tions (tuberculosis, syphilis, streptococcus, staphylococcus, etc.), sarcoidosis, and take an important place in the differential diagnosis of Hodgkin's disease Lupus Erythematosus. Suspicious cases, biopsy, mediastinoscopy and mediastinal biopsy, lenfanjiyografı, thoracotomy, laparotomy is necessary. Computer axial tomography in diagnosis has an important place.

Treatment

Radiation Therapy Radiation therapy is usually the best treatment of localized Hodgkin's disease. The disease is a common treatment of nature is done in the shimmy. For diagnostic biopsy rather than surgical intervention, and some are special cases. And now with radiation therapy is applied in some cases (adjuvant therapy).

Hodgkin's disease, drug use more than one day of the month provides a better regression. Cytostatic drugs are given together with steroids many times 3. For example, the combined drug cyclophosphamide, vincristine, methotrexate and prednisone can be used as cytostatics. Another combination therapy of nitrogen mustard, vincristine, procarbazine, and prednisone are provided with. Combination drug therapy is 2-3 weeks and a day about 6 cycles are repeated. These periods may vary according to cases.

Prognosis

Hodgkin's disease often show a chronic development. In some cases, despite the rapid progress of the treatment is monitored. The average duration of 3-4 years to live. Usually, only one region in lymphadenopathy, weight loss and fever, increased sedimentation and changes in blood in cases such as the absence of systemic symptoms and survival time is longer and slower development of disease. Prognosis for a careful assessment of history, examination, blood examination, liver function tests, X-ray examination, if necessary, should be lenfanjiyografı. Hodgkin's disease can be classified in four;

l.Hodgkin disease begins before the anatomical region. 2. Over time, the neighboring regions shows deployments. 3. The disease is more common. However, above or below the diaphragm. 4. More advanced stages of disease parenkiması lung, pleura, liver, bone, kidneys, gastrointestinal tract and spreads to other organs. Systemic spread is a chronic cases, survival time in a year.