Hodgkin's lymphoma examination and diagnosis

examination

1. Laboratory examination

Anemia is more common in advanced patients, and is normal pigment and orthocytic anemia. Hemolytic anemia is occasionally seen and Coombs test is positive in 2% to 10% of patients. A small number of cases may have increased neutrophils and eosinophils. Decrease in peripheral blood lymphocytes (<1.0×109/L), increase in erythrocyte sedimentation rate, and increase in serum lactate dehydrogenase can be used as disease detection indicators.

2. Histopathology

The structure of normal lymphatic tissues such as lymph nodes at the lesion site is completely or partially destroyed, showing a variety of non-tumor reactive cell components, mostly lymphocytes, and visible plasma cells, eosinophils, neutrophils, histiocytes, and fibroblasts And fibrous tissue. The typical RS cells and their variants are scattered in a variety of reactive cell background components. Typical RS cells are binuclear or multinucleated giant cells with eosinophilic nucleoli, large and obvious, and rich in cytoplasm. If the cells exhibit symmetrical dual nuclei, they are called "mirror cells". RS cells and atypical (variant) RS cells are considered to be true tumor cells of Hodgkin's lymphoma. Recently, single-cell microscopy combined with immunophenotyping and genotype testing has proved that RS cells are derived from lymphocytes, mainly from B lymphocytes. The positive expression of CD15 and CD30 antigens in RS cells of typical Hodgkin’s lymphoma is an important immune marker for the recognition of RS cells.

3. Imaging diagnosis

(1) X-ray plain film usually shows asymmetric nodules in the bilateral anterior and superior mediastinum, with very few calcifications, unless after radiotherapy.

(2) CT can show multiple and larger soft tissue masses without necrosis, bleeding or cystic change, and the enhancement scan enhancement is not obvious. Swollen nodules can eventually lead to significant space-occupying effects.

(3) MRI can show uniform signal masses with low T1WI signal and high T2WI signal intensity due to edema and inflammation.

(4) PET Positron Emission Laser Tomography (PET) is conducive to comprehensive assessment of disease stage and treatment effect, and is currently used as an important imaging method.

Differential diagnosis

This disease needs to be differentiated from lymphoid tuberculosis, viral infections such as infectious mononucleosis, and non-Hodgkin’s lymphoma, and attention should be paid to distinguish it from metastatic cancer. Neck lymph node enlargement should be excluded from nasopharyngeal carcinoma, thyroid cancer, etc., and mediastinal masses should be excluded from lung cancer and thymoma. Axillary lymphadenopathy should be differentiated from breast cancer. The identification of the above diseases mainly depends on histopathological examination, and histopathological diagnosis is a necessary basis for the diagnosis of Hodgkin’s lymphoma. Pathological diagnosis usually requires typical RS cells, combined with the overall tissue performance of lymphocytes, plasma cells, eosinophils and other reactive cell components, and combined with immune markers such as CD15 and CD30 to make a diagnosis.