Hodgkin's disease and the malignant lymphomas

摘要: Abstract The unanticipated finding of a subcutaneous swelling, typically an enlarged lymph node in the neck, is legitimate cause for concern. After excluding benign or reactive conditions, this sign should initiate series investigations to characterize neoplasm and, case lymphoma, lead prompt treatment aimed at cure. classic description such cervical adenopathy that by Thomas Hodgkin, who clearly recorded both clinical behavior and macroscopic findings evident dissection. Subsequent histologic study revealed multinucleate giant cells tumor now bears his name linked it those Greenfield, Sternberg, Reed. Initial debate centered on whether entity was inflammatory malignant, with issue further clouded frequent coexistence tuberculosis. Although number features exist favor concepts, current consensus places among neoplastic processes. Hodgkin's disease separated from other malignant lymphomas as agreement diagnostic criteria emerged. next major step forward demonstration, first Vera Peters then Henry Kaplan, adequate doses radiotherapy were curative when delivered fields encompassed tumor. A milestone introduction Vincent DeVita, Jr., colleagues combination chemotherapy effective late stage disseminated disease. established cornerstones managing these patients are accurate diagnosis; precise anatomic staging, modified appropriate associated factors known have prognostic value; selection irradiation, chemotherapy, whatever will result best possible patient survival. However, success not universal, death due resistant relapsing encountered all too frequently. It here benefits multidisciplinary approach evident, because substantial level expertise coupled sound judgment needed salvage individuals, often means investigational programs. Some latter limited profound myelosuppression, safety may center use cytokines form interleukins growth factors, without bone marrow transplantation. In situations, benefit must be balanced against risks well-structured trials embody informed consent. Herein lies one goals decade. non-Hodgkin's can conveniently considered two broad categories. follow indolent course, which retains follicular pattern small component cells, others aggressive tumors, primitive blasts diffusely effaced glandular architecture. Unfortunately, practical observations obscured publication many widely divergent classifications. semblance order instilled into confusion Working Formulation, which, comparing approaches, provided framework translation between disparate terminologies. One limitation, however, did readily lend itself greater flexibility incorporate immunophenotyping. instructive contrast ends spectrum, each their distinctive histopathologic counterparts. First low-grade variants, occur older age group slow progression tend presentation. consequence natural history has been willingness doctors palliate individuals minimal amounts alkylating agents even low-dose total-body prolong good-quality survival but inevitable steady erosion hematopoietic reserve. Attempts made improve outcome, using regimens appropriately selected patients, including high cytotoxic rapid reversal myelosuppression Any program presupposes well share decision-making process, objectively balance potential hazards. Second high-grade initially incorrectly called reticulum cell sarcomas, renamed histiocytic neoplasms, recognized predominantly immunophenotypically B-cell origin. tumors includes short poor response rate drug regimens. Dramatic improvement followed anthracycline-containing combinations, so eradication achieved over 40% late-stage patients. Despite this, challenges still remain Here, more complex programs steep dosage escalation, requiring some support, being evaluated. Such heroic efforts acknowledge importance achieving complete remission en route cure, goal therapy. ethically protocols nature undergo careful scrutiny institutional review boards protect patients' rights expectations while also maintaining proper perspective resource allocation. Important conclusions cure entirely realistic objective therapy lymphoreticular malignancy. This, turn, critically dependent early diagnosis, reliable optimal irradiation conventional chemotherapy. Furthermore, well-defined provide additional recognizing poor-risk categories alternatively treated intensive approaches. variety new options available, cytokines, transplantation, biologic immune modulation interferon monoclonal antibodies designed destroy abnormal what become scrotherapy. stressed comprehensive management most effectively approach, creates milieu likely results, therefore referral cancer interests.