lymphoma diagnosis | Hodgkin lymphomas: Symptoms and diagnosis

Hodgkin lymphomas: Symptoms and diagnosis

In most cases, Hodgkin's lymphoma is manifested by an increase in the volume of one or more lymph nodes. Only the biopsy can establish the definitive diagnosis. Further examinations should be conducted to identify the exact nature of Hodgkin's lymphoma and thus provide the patient with the most appropriate treatment.

The Symptoms
Hodgkin's lymphoma is often manifested by the presence of one or more large and asymmetric lymph nodes in the neck (known as the cervical ganglion or susclaviculaire) and/or more rarely in the armpits or groin.

In most cases, the disease also affects a non-detectable mediastinal ganglion (deep lymph node located in the area between the lungs). In 35% of cases, it starts at the level of a cervical ganglion. More rarely, the disease first reaches a deep ganglion of the abdomen (10% of cases) or armpit (5% of cases). It then extends to other lymph nodes and organs by advancing through the lymphatic pathways.

Lymph nodes also grow when the organism fights an infection, which is a common situation. This is why the doctor must first check that these symptoms are not related to a viral or bacterial infection. Other signs, which are not very evocative, are frequently encountered: important nocturnal sweats, unexplained weight loss or even persistent fever.

The diagnosis
The diagnosis of lymphoma is based on the analysis of a tissue sample obtained by biopsy.

It is a matter of surgically taking a piece of ganglion (or the whole ganglion) in order to study it under a microscope. The biopsy usually takes place under local anesthesia for the superficial ganglia (neck, armpit, groin). In cases where the lymph node is deep, the biopsy can be guided by imaging through the scanner.

Carried out by a specialist doctor called Pathologist, the Anatomopathologic examination allows to observe the cells of Reed Sternberg characteristic of Hodgkin's lymphoma. They are giant cells of a specific appearance. Their environment with signs of inflammation is also visible under a microscope. In addition, it is possible to properly characterize Reed Sternberg cells by using antibodies that recognize molecules present at their membranes (the expression of CD30 is obligatory for diagnosis). In general, it takes a week of days between the biopsy and the definitive diagnosis.

Some simple tests are used to orient the diagnosis as an acceleration of the sédimentationou rate an increase in C-reactive protein.

The extension balance
Often carried out at the same time as the diagnosis, the extension balance is essentially based on imaging tests that determine the number of sites affected by the disease. Various imaging techniques are used, such as the Scanner and PET (positron emission tomography), which enable the retrieval of all lymphoma locations and the early estimation of the response to available treatments. In some cases, the hematologist requires a medullary biopsy: bone marrow analysis, taken from the pelvic bone, can be used to check the presence of tumor cells at this site.

However, medullary biopsy is less and less practiced as a result of the systematic use of pet.
The general balance sheet
The final stage of the diagnosis is to make the patient's overall assessment. The healthcare team also talks about pretherapeutic checkups. This includes measuring how the heart and lungs work in order to choose the most suitable treatment according to the general condition of the patient. As chemotherapy weakens immune defenses, infection sites are sought (e.g. dental control). It is also necessary to detect, prior to treatment, possible infections with AIDS (HIV) viruses or hepatitis B and C viruses. Finally, a sperm-preservation is offered to men. For young women, fertility preservation techniques are also being considered.

The classification
The anatomopathologic examination and the extension balance are used to establish a classification of lymphoma. Several classifications exist. In France, hematologists use the ANN Harbor classification to which other criteria such as general signs and sedimentation velocity are added. The ANN Arbor classification distinguishes four stages: stage I: Lymphoma is located at a single node group;
Stage II: Lymphoma is located in several groups of lymph nodes but located on the same side of the diaphragm;
Stage III: Lymphoma is present in several groups of lymph nodes on both sides of the diaphragm;
Stage IV: In addition to lymph nodes, lymphoma affects one or more organs (lung, bone, liver, bone marrow).
When general signs are present (a persistent fever greater than 38 °c, night sweats or slimming over 10% of body weight), the letter B is added. The letter A is used in the absence of these signs.

This dossier was made thanks to the competition of Dr. Pauline Brice, hematologist at the Hôpital Saint-Louis (Paris) and Chair of the Scientific Committee of the Association France Lymphoma Hope.