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{{Infobox - onemocnění
| česky = Hodkinův lymfom
| obrázek = Hodgkin Lymphoma CT2.jpg
| popisek = CT obraz pacientky trpící Hodkinovým lymfomem
| anglicky = Hodgkin's lymphoma
| latinsky = ''Morbus Hodkin''
| původce =
| patogeneze =
| rizikové faktory = 
| přenos =
| inkubační doba = 
| klinický obraz = nebolestivé zvětšení uzlin, [[horečka]] ([[Pelova-Ebsteinova horečka|Pelova-Ebsteinova]]), svědění, pocení, malátnost, únava, pokles hmotnosti apod.
| diagnostika = extirpace uzliny, histopatologické vyšetření, [[rtg]] hrudníku, [[sono]] břicha, [[scintigrafie]] jater, sleziny, [[CT]] a lymfografie, [[PET]], trepano[[biopsie]] kostní dřeně.
| infekčnost =
| léčba =  kombinovaná [[Protinádorová terapie#Chemoterapie|chemoterapie]], doplňujeme radioterapií
| komplikace =
| očkování =
| incidence v ČR =
| prevalence v ČR =
| mortalita ve světě =
| mortalita v ČR =
| MKN = {{MKN-10|C81-C96|C81}}
| MeSH ID = {{MeSH ID|D006689}}
| OMIM =
| MedlinePlus = {{MedlinePlus|000580}}
| Medscape = {{Medscape|201886}}
}}
'''Hodgkin lymphoma,''' or '''malignant lymphogranuloma''', is a cancer of the lymphatic tissue. The exact etiology is unknown (genetic predisposition, [[immune disorder]], [[EBV]], [[HIV]]). It is most often diagnosed between the ages of 20 and 30 and after the age of 50. The disease emerges in the [[Lymph node]] (most often in axial lymph nodes), from where it it spread to neighboring lymph nodes as well as to the systemic circulation.
'''Hodgkin lymphoma,''' or '''malignant lymphogranuloma''', is a cancer of the lymphatic tissue. The exact etiology is unknown (genetic predisposition, [[immune disorder]], [[EBV]], [[HIV]]). It is most often diagnosed between the ages of 20 and 30 and after the age of 50. The disease emerges in the [[Lymph node]] (most often in axial lymph nodes), from where it it spread to neighboring lymph nodes as well as to the systemic circulation.


Histologically, they are divided according to the number of '''Reed-Sternberg cells''' (cells formed by mutated [[B-cell]]) and according to the degree of cellular response.  
Histologically, they are divided according to the number of '''Reed-Sternberg cells''' (cells formed by mutated [[B-cell]]) and according to the degree of cellular response.  


* '''type I''' is with predominant [[Lymphocyte|lymphocytes]] (few RS cells with many [[Lymphocyte|lymphocytes]]; best prognosis) (5%);
* '''type I''' is also known as lymphocyte-rich HL with predominant [[Lymphocyte|lymphocytes]] (few RS cells with many [[Lymphocyte|lymphocytes]]; best prognosis) (5%);
* '''type II''' is also known as nodular sclerosing Hodgkin lymphoma (NSHL) (nodular foci, cells (reticulocyte
* '''type II''' is also known as nodular sclerosing Hodgkin lymphoma (NSHL) (nodular foci with reticular cells, lymphocytes and histiocytes surrounded by collagens) (70%);
*'''type III''' is also known as mixed cellularity type (20-25%);
*'''type IV''' is also known as lymphocyte-depleted HL with small populations of lymphocytes (abundant proliferated RS cells; worst prognosis) (1%).
 
== Clinical Manifestation ==
* Painless enlargement of the nodes (cervical, axillary, inguinal);
*[[Fever (pediatrics)]] (typically with [[Pel-Ebstein Fever|Pel-Ebstein fever]]), itching, sweating, malaise, fatigue, weight loss;
*[[Splenomegaly]];
*cough, dyspnea, [[superior vena cava syndrome]] (involvement of [[mediastinum]]);
*pleural/pericardial effusion, infiltration of parenchymal organs and/or bone marrow (in advanced stages).
== Diagnostics ==
* Nodular extirpation and its subsequent histopathological examination - the presence of RS cells or Hodgkin's cell (RS cell precursors)
*[[Chest imaging|Chest X-ray]], abdominal [[ultrasound]], [[scintigraphy]] of liver, spleen, [[Computed tomography|CT]] and [[lymphography]], [[Positron emission tomography|PET]];
*Trepanobiopsy of bone marrow.
== Stages ==
[[File:Hodgkin lymphoma cytology large.jpg|thumb|right|Mikroskopický obraz Hodgkinova lymfomu]]
 
* '''Stage I''' (involvement of single lymph node region or one extra-lymphatic organ);
* '''Stage II''' (involvement of 2 or more lymph node regions on a same side of diaphragm);
* '''Stage III''' (involvement of lymph node on both sides of the diaphragm, including extra-lymphatic organ or spleen);
* '''Stage IV''' (disseminated involvement of extra-lymphatic organs independent of nodal involvement).


== Klinický obraz ==
Each stages are further divided into A and B:
* Nebolestivé zvětšení uzlin (krční, axilární, ingvinální);
* [[horečka]] (typická [[Pelova-Ebsteinova horečka|Pelova-Ebsteinova]]), svědění, pocení, malátnost, únava, pokles hmotnosti;
* [[splenomegalie]];
* kašel, dušnost, [[syndrom horní duté žíly]] (při postižení [[mediastinum|mediastina]]);
* výpotek, infiltrace parenchymatózních orgánů, skeletu (při pokročilém postižení).
== Diagnostika ==
* Extirpace uzliny a její následné histopatologické vyšetření – přítomnost R-S buněk, nebo buněk Hodgkinových (prekurzory R-S buněk);
* [[rtg]] hrudníku, [[sono]] břicha, [[scintigrafie]] jater, sleziny, [[CT]] a [[lymfografie]], [[PET]];
* trepano[[biopsie]] kostní dřeně.
== Stádia ==
[[Soubor:Hodgkin lymphoma cytology large.jpg|thumb|right|Mikroskopický obraz Hodgkinova lymfomu]]
* '''Stádium I''' (postižení jedné lymfatické oblasti, nebo jednoho extralymfatického orgánu);
* '''stádium II''' (postižení dvou nebo více oblastí na jedné straně bránice);
* '''stádium III''' (postižení lymfatických uzlin na obou stranách bránice, i s extralymfatickým orgánem, nebo slezinou);
* '''stádium IV''' (diseminované postižení extralymfatických orgánů nezávisle na postižení uzlin).


Dále se každé stádium dělí na A a B:
* A- the patient is without systemic symptoms;
* '''A''' – pacient je bez celkových příznaků;
* B - the patient is with systemic symptoms (weight loss of 10% in 6 months, fever more than 38 ° C, night sweats).
* '''B''' – s celkovými příznaky (úbytek na váze o 10 % za 6 měsíců, horečka více než 38 °C, noční pocení).


== Komplikace ==
== Complications ==
* [[Infekce]], míšní komprese při postižení obratlů.
* [[Infection|Infections]], spinal cord compression when the vertebrae are affected.


== Terapie ==
== Therapy ==
Základní léčebnou modalitou je systémová léčba ve formě kombinované [[Protinádorová terapie#Chemoterapie|chemoterapie]], v lokalizovaných stádiích jí doplňujeme radioterapií. Základní používané režimy: '''ABVD''' (adriamycin, bleomycin, vinblastin, dekarbazin), '''BEACOPP''' (bleomycin, etoposid, adriamycin, cyclofosfamid, vinkristin, prokarbazin, prednison).
The basic treatment method is systemic treatment by a combined [[chemotherapy]], in localized stages radiotherapy is used to supplement. Basic regimens used are: '''ABVD''' (adriamycin, bleomycin, vinblastine, decarbazine), '''BEACOPP''' (bleomycin, stoposide, adriamycin, cyclophosphamide, vincristine, procarbazine, prednisone).  
* '''Lokalizovaná''' (časná) stádia I,II: s příznivou prognózou (bez rizikových faktorů) 2× ABVD a radioterapie 20 Gy, s nepříznivou prognózou (s rizikovými faktory) 2× BEACOPP + 2× ABVD a radioterapie 20 Gy.
* '''Localized''' (early) stages I, II: 2 × ABVD and radiotherapy 20 Gy with favorable prognosis (without risk factors). 2×BEACOPP + 2×ABVD and radiotherapy 20 Gy with unfavorable prognosis (with risk factors)
* '''Pokročilá''' stádia III, IV: 6× BEACOPP eskalovaného režimu.
*'''Advanced''' stages III, IV: 6×BEACOPP escalated mode
* V případě relapsu – '''záchranný režim''' (založený na platinových derivátech), autologní [[transplantace]].
*In recurrent cases - '''rescue regimen''' (based on platinum derivatives), autologous [[transplantation]].
* '''Nové léky''' – k léčbě relapsů se používá ''brentuximab vedotin'' (anti-CD30 protilátka). <ref>{{Citace
*'''New drugs''' - brentuximab vedotin (anti-CD30 antibody) is used to treat recurrent HL. <ref>{{Cite
| typ = kniha
| type = book
| isbn = 978-80-7387-895-5
| isbn = 978-80-7387-895-5
| příjmení1 = Češka
| surname1 = Češka
| jméno1 = Richard
| name1 = Richard
| kolektiv = ano
| others = yes
| titul = Interna
| title = Interna
| vydání = 2
| edition = 2
| místo = Praha
| location = Praha
| vydavatel = Triton
| publisher = Triton
| rok = 2015
| year = 2015
| rozsah = 909
| range = 909
}}</ref>
}}</ref>
== Prognóza ==
== Prognosis ==
Pacienti mají dobrou prognózu, asi 70–80 % pacientů se vyléčí. Nádor má dobrou kurabilitu.
Patients have a good prognosis, about 70-80% of patients recover. The tumor is curable.
<noinclude>
== Links ==
 
== Odkazy ==
=== Související články ===
=== Související články ===
* [[Maligní lymfom]]
* [[Malignant lymphoma]]
* [[Nehodgkinské maligní lymfomy]]
* [[non-Hodgkin malignant lymphoma]]
* [[Difuzní velkobuněčný B-lymfom]]
* [[Diffuse large B-cell lymphoma]]
* [[Leukémie]]
* [[Leukemia]]
* [[Chemoterapie]]
* [[Chemotherapy]]
* [[Radioterapie]]
* [[Radiotherapy]]
=== Reference ===
=== Reference ===
<references />
<references />
=== Použitá literatura ===
=== Bibliography ===
* {{Citace
* {{Cite
| typ = kniha
| type = book
| isbn = 978-80-7387-895-5
| isbn = 978-80-7387-895-5
| příjmení1 = Češka
| surname1 = Češka
| jméno1 = Richard
| name1 = Richard
| kolektiv = ano
| others = yes
| titul = Interna
| title = Interna
| vydání = 2
| edition = 2
| místo = Praha
| location = Praha
| vydavatel = Triton
| publisher = Triton
| rok = 2015
| year = 2015
| rozsah = 909
| range = 909
}}
}}
* {{Citace
* {{Cite
| typ = kniha
| type = book
| isbn = 978-80-7262-705-9
| isbn = 978-80-7262-705-9
| příjmení1 = Klener
| surname1 = Klener
| jméno1 = Pavel
| name1 = Pavel
| kolektiv = ano
| others = yes
| titul = Vnitřní lékařství
| title = Vnitřní lékařství
| vydání = 4
| edition = 4
| místo = Praha
| location = Praha
| vydavatel = Galén, Karolinum
| publisher = Galén, Karolinum
| rok = 2011
| year = 2011
| rozsah = 1174
| range = 1174
}}
}}
{{Navbox - onemocnění krve}}
 
=== Classifications and references ===
 
* MKN-10 - [https://old.uzis.cz/cz/mkn/C81-C96.html#C81 C81]
* MeSH ID - [https://www.medvik.cz/link/D006689 D006689]
* MedlinePlus - [https://medlineplus.gov/ency/article/000580.htm 000580]
* Medscape - [https://emedicine.medscape.com/article/201886-overview 201886]
 
</noinclude>
</noinclude>
[[Kategorie:Hematologie]]
[[Category:Pathology]]
[[Kategorie:Patologie]]
[[Category:Oncology]]
[[Kategorie:Onkologie]]
[[Category:Hematology]]
[[Kategorie:Vnitřní lékařství]]
[[Category:Internal Medicine]]

Latest revision as of 00:06, 19 February 2022

Hodgkin lymphoma, or malignant lymphogranuloma, is a cancer of the lymphatic tissue. The exact etiology is unknown (genetic predisposition, immune disorder, EBV, HIV). It is most often diagnosed between the ages of 20 and 30 and after the age of 50. The disease emerges in the Lymph node (most often in axial lymph nodes), from where it it spread to neighboring lymph nodes as well as to the systemic circulation.

Histologically, they are divided according to the number of Reed-Sternberg cells (cells formed by mutated B-cell) and according to the degree of cellular response.

  • type I is also known as lymphocyte-rich HL with predominant lymphocytes (few RS cells with many lymphocytes; best prognosis) (5%);
  • type II is also known as nodular sclerosing Hodgkin lymphoma (NSHL) (nodular foci with reticular cells, lymphocytes and histiocytes surrounded by collagens) (70%);
  • type III is also known as mixed cellularity type (20-25%);
  • type IV is also known as lymphocyte-depleted HL with small populations of lymphocytes (abundant proliferated RS cells; worst prognosis) (1%).

Clinical Manifestation[edit | edit source]

Diagnostics[edit | edit source]

  • Nodular extirpation and its subsequent histopathological examination - the presence of RS cells or Hodgkin's cell (RS cell precursors)
  • Chest X-ray, abdominal ultrasound, scintigraphy of liver, spleen, CT and lymphography, PET;
  • Trepanobiopsy of bone marrow.

Stages[edit | edit source]

Mikroskopický obraz Hodgkinova lymfomu
  • Stage I (involvement of single lymph node region or one extra-lymphatic organ);
  • Stage II (involvement of 2 or more lymph node regions on a same side of diaphragm);
  • Stage III (involvement of lymph node on both sides of the diaphragm, including extra-lymphatic organ or spleen);
  • Stage IV (disseminated involvement of extra-lymphatic organs independent of nodal involvement).

Each stages are further divided into A and B:

  • A- the patient is without systemic symptoms;
  • B - the patient is with systemic symptoms (weight loss of 10% in 6 months, fever more than 38 ° C, night sweats).

Complications[edit | edit source]

  • Infections, spinal cord compression when the vertebrae are affected.

Therapy[edit | edit source]

The basic treatment method is systemic treatment by a combined chemotherapy, in localized stages radiotherapy is used to supplement. Basic regimens used are: ABVD (adriamycin, bleomycin, vinblastine, decarbazine), BEACOPP (bleomycin, stoposide, adriamycin, cyclophosphamide, vincristine, procarbazine, prednisone).

  • Localized (early) stages I, II: 2 × ABVD and radiotherapy 20 Gy with favorable prognosis (without risk factors). 2×BEACOPP + 2×ABVD and radiotherapy 20 Gy with unfavorable prognosis (with risk factors)
  • Advanced stages III, IV: 6×BEACOPP escalated mode
  • In recurrent cases - rescue regimen (based on platinum derivatives), autologous transplantation.
  • New drugs - brentuximab vedotin (anti-CD30 antibody) is used to treat recurrent HL. [1]

Prognosis[edit | edit source]

Patients have a good prognosis, about 70-80% of patients recover. The tumor is curable.

Links[edit | edit source]

Související články[edit | edit source]

Reference[edit | edit source]

  1. ↑ ČEŠKA, Richard, et al. Interna. 2. edition. Praha : Triton, 2015. 909 pp. ISBN 978-80-7387-895-5.

Bibliography[edit | edit source]

  • ČEŠKA, Richard, et al. Interna. 2. edition. Praha : Triton, 2015. 909 pp. ISBN 978-80-7387-895-5.
  • KLENER, Pavel, et al. Vnitřní lékařství. 4. edition. Praha : Galén, Karolinum, 2011. 1174 pp. ISBN 978-80-7262-705-9.


Classifications and references[edit | edit source]

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