Correct!
4. Recurrent Hodgkin’s disease
Hodgkin’s disease is a B cell lymphoma representing about 10% of all lymphomas and 0.6% of all cancers. Hodgkin’s has a bimodal age distribution with peaks in the 20s and about 65. Numerous risk factors have been ascribed but none are clearly associated with the disease. Clinically, it is usually associated with painless, localized, peripheral lymphadenopathy. Sometimes fever, weight loss and sweats are present. These are the “B” symptoms which suggest more advanced disease. Pruritis is another important symptom which is not a “B” symptom but can precede clinical development of lymphadenopathy.
Hodgkin’s requires a biopsy of a lymph node for diagnosis. It is defined by the presence of diagnostic Reed-Sternberg (RS) cells in an inflammatory background containing a variable number of small lymphocytes, eosinophils, neutrophils, macrophages (also referred to as histiocytes), plasma cells, fibroblasts, and collagen fibers. Hodgkin’s should stain with CD30 but not CD45.
Hodgkin’s starts at a single lymph node and progresses to adjacent lymphatics. It is unusual to have diffuse pulmonary involvement without hilar involvement at initial presentation. Non contiguous spread and hematologic spread are more common with recurrent disease.
This patient is undergoing additional chemotherapy with plans to undergo an allogenic stem cell transplant in the future.
We did promise a picture of Millet seeds (Figure 4).
Figure 4. Millet seeds.
References