Classical Hodgkin lymphoma: nodular sclerosis


2018-03-19 03:35:21




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Nodular sclerosis – this histological type of Hodgkin's disease, characterized by a dense growth of connective tissue, dividing into a mass of irregularly shaped cells and slices. They contain proliferating lymphoid matter with a large number of cells Berezovsky-Sternberg. The disease begins with increasing nodes. This pathology is one of the variants of classical Hodgkin's lymphoma.

Hodgkin's Disease is considered a serious ailment that affects the lymphatic system. The disease can occur in any organ that has lymphatic tissue (thymus, tonsils, spleen, adenoids, etc.).nodular sclerosis

Nodular sclerosis symptoms

Hodgkin Lymphoma can be a person, if he has symptoms such as:

  • Weight loss;
  • Swollen lymph nodes (often in the neck area);
  • Loss of appetite;
  • Shortness of breath;
  • Night sweating or fever;
  • Chest pain;
  • Enlarged liver (5 % of patients) or spleen (30% patients);
  • Heaviness or pain in the abdomen (in children);
  • Itching (only 1/3 of people suffering from illness);
  • Difficult breathing;
  • Cough.


Chlamydia can be infected at any age, but more often it occurs in young men age category from 16 to 30 years of age or elderly people over 50 years old. Children under 5 years, almost never get sick. What exactly triggers this disease is still unknown. However, there is an assumption that the source-viruses. It is believed that to trigger the beginning of this ailment can:

  • Immunodeficiency States;
  • Infectious mononucleosis (excited by the Epstein-Barr).

Nodular sclerosis Hodgkin's lymphoma can take place instantly, lasts from 3 to 6 months or extended up to 20 years.nodular sclerosis Hodgkin's lymphoma


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What stage is the disease?

The Degree hodinskoe of lymphoma are determined according to the results of laboratory studies and on the basis of the following indicators:

  • The number of affected lymph nodes and their location;
  • The presence of these nodes in different regions of diaphragm;
  • Tumors in other organs (e.g. the liver or the spleen).

The First stage. In this case, it affects only one lymph node or lymphoid organ (spleen, ring Pirogov-Valdera).

The Second stage. There is usually affected lymph nodes on both sides of the chest, diaphragm and lymphoid organs.

The Third stage. This degree Hodgkin's lymphoma is nearly indistinguishable from second stage. However, it has two kinds of nodular sclerosis third stage:

  • In the first case, affected organs located below the diaphragm (the celiac lymph nodes, spleen);
  • In addition to the areas listed in the first type, struck more and other places with the lymph nodes near the diaphragm.

The Fourth stage. Affects not only nodes, but also non-lymphoid organs-bone marrow, liver, bones, lungs and skin.

Denote the degree Hodgkin's lymphoma

Indicator of the severity of the clinical situation and the painful occurrence of other tissues and organs is marked by the letters.

A – severe manifestations of the disease.

B – the presence of one or more symptoms (unjustly increased temperature, sweating at night, rapid weight loss).

E – the lesions spread to the tissues and organs located near the affected lymph nodes.

S – there is loss of the spleen.

X – there is a serious tumor of enormous size.lymphoma, nodular sclerosis

The Histological types of the disease

Regarding the cell structure of chlamydia there are 4 forms of ailments.

  1. Nodular sclerosis Hodgkin's lymphoma – this is the most common form of the disease, approximately 40-50 % of all cases. They are sick more often young women, which affects the lymph nodes of the mediastinum. In biopsy material, in addition to the cells Berezovsky-Sternberg are still large lacunar cells with foamy cytoplasm and a mass of nuclei. Prediction in this disease is usually good.
  2. Lymphohistiocytic lymphoma, which is formed in 15% of samples. Often it can be found in young men under 35. Has an excellent five-year survival with cells Mature Lipatov and Strenberg. This kind of illness with a small malignancy and it is identified in the initial stages.
  3. Combined kind is usually diagnosed in the elderly and children. Different characteristic of a typical clinical picture and a tendency to generalization actions. Histological examination revealed different compounds of the cells, including Sternberg. Found in 30% of patients with lymphoma. Nodular sclerosis in this case has a relatively good prognosis, and, if time treatment, no problem coming solid remission.
  4. Dangerous granuloma with destruction of the lymphoid tissue there is infrequently, only in 5% of cases (mostly among the elderly). A characteristic feature here is that there are no lymphocytes and the predominant cells Sternberg. This form of lymphoma has the lowest percentage of five-year survival rate.nodular sclerosis symptoms


Diagnosis "lymphoma" is determined only by the histological examination of the lymph nodes and is proven only in the case when the result of the study revealed the particular multi-Sternberg cells. In severe examples, the need immunophenotyping. Cytological analysis of a lymph node or puncture of the kidney is usually not enough to confirm nodular sclerosis type 1. What needs to be done to establish the diagnosis of the disease:

  • General and biochemical blood analysis;
  • Chest x-ray (mandatory in lateral and frontal projection);
  • A biopsy of a lymph node;
  • Ultrasonic inspection of all types of peripheral and abdominal lymph nodes, thyroid, liver and spleen;
  • CT scan of the mediastinum to eliminate imperceptible lymph nodes in traditional x-rays;
  • Trephine-biopsy of the Ilium, to exclude bone marrow failure;
  • Scan and x-rays of the bones.


Contains radiation treatment, surgery and chemotherapy. The choice of the method is set by the stage of illness and the presence of positive or negative prognostic reasons. To the favorable factors include:

  • Identify the histological examination of the nodular sclerosis and lymphohistiocytic type;
  • Age less than 40 years;
  • The volume of lymph nodes that do not exceed 6 cm in diameter;
  • The lack of a common manifestations biological effectiveness (developments in blood biochemical parameters);
  • The presence of no more than 3 locations destruction.

If there is not at least one of these causes, then the patient is referred to a group with a poor prognosis.nodular sclerosis third stage

Radiation therapy

Complete radiation therapy as an individual form is used for patients with stages IA and IIA, confirmed at laparotomy, and having good prognostic factors. It makes free fields with exposure to all types of affected lymph nodes and passages of the flow of lymph.

The Total absorbed dose in metastatic lesions is 40-45 g over 4-6 weeks in areas of preventive radiation – 30-40 g for 1-4 weeks. Also use multiple methods of wide-field irradiation of certain lesions to prevent nodular sclerosis ns1.

Radiation treatment can cause complications such as fibrosis of the subcutaneous tissue, radiation pulmonic and pericarditis. Deterioration appear in a variety of period – from 3 months to 5 years after therapy. Their complexity depends on the used dose.


Surgical treatment is not often used separately, neobychno is an integral part of therapy in the complex. Perform a splenectomy, as well as operations on the trachea, the esophagus, stomach and other organs (if there is a danger of asphyxia, disorders of the passage of food). Discovered when occurring chlamydia pregnancy should be interrupted.a variant of Hodgkin's lymphoma nodular sclerosis


This type is used as a component of comprehensive treatment. To cure nodular sclerosis, used in different preparations:

  • Alkaloids (“Vinblastine” or “Rozevin”, “Etoposide” or “Vincristine, “Oncovin");
  • Ulcerous mixture (“Mustargen”, “Cyclophosphamide” or “Ambien”, “Nitrosomethylurea” or ‘Chlorambucil");
  • Synthetic products (“Natulan” or “Procarbazine”, “Dacarbazine” or “Imidazole Carboxamide,");
  • Antitumor antibiotics (“Bleomycin”, “Adriablastin”).


Is Used only in special cases with exponential nomination...

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Alin Trodden - author of the article, editor
"Hi, I'm Alin Trodden. I write texts, read books, and look for impressions. And I'm not bad at telling you about it. I am always happy to participate in interesting projects."

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