Lymphogranulomatosis (Hodgkin's lymphoma) is a malignant change in the lymphoid tissue. It manifests itself in the form of an increase in the lymph nodes, most often the supraclavicular, mandibular or axillary nodes are affected. The process begins in one of the lymph nodes and then spreads throughout the body. The disease is successfully treated, the patient is under constant control after the course of therapy, since the disease tends to return.
What is lymphogranulomatosis
The disease begins with the simultaneous appearance of granulomas and Berezovsky-Sternberg cells in any one lymph node. Education is considered by the immune system as an aggressive foreign agent and is attacked by leukocytes. Lymphocytes, erythrocytes, eosinophils and other cells are sent to neutralize and remove a foreign formation, designed to protect the internal environment of the body.
They form a dense barrier of cells around the affected node. The whole structure, condensing, is formed into a granuloma, in which inflammatory processes occur.processes that gradually increase the size of the node - this is lymphogranulomatosis.
Symptoms continue to increase as the disease progresses. Altered clones of cells migrate through the system of lymph nodes, as well as to neighboring organs and tissues. Settling in new areas, pathological cells provoke a wave of growth of new granulomas. Gradually overgrown malignant cells replace he althy tissue, which leads to disruption of the organs.
The patient has an enlarged spleen, weight loss, general weakness. At the present stage, medicine has an accurate understanding of the methods of treatment, but the causes and prerequisites for the occurrence of pathology remain unclear.
Cancer or not?
From the point of view of medicine, cancer is a mutation of the epithelial tissue, in which the affected cells grow in the lumen of the internal organs. The tissue of the lymph nodes does not belong to the epithelial, therefore, from a scientific point of view, lymphogranulomatosis is not an oncology in the literal sense. But there are also common signs that combine cancer and Hodgkin's disease.
Symptoms and common features:
- Infiltrating (malignant) cell growth, germination in neighboring organs and tissues (metastases).
- Intoxication of the body, exhaustion of the patient.
- The same principle of treatment - the destruction of mutated cells by chemotherapy and radiation therapy.
Patients, at the level of communication with specialists, call lymphogranulomatosis one of the forms of cancer, and this does not cause opposition or objections from doctors.
Causes of occurrence
Today, medicine can diagnose lymphogranulomatosis with high accuracy. The symptoms and clinical picture of the disease are known to doctors, but the causes of the onset of the disease, like all cancers, are not known for certain. According to long-term statistics, people of two age categories are most susceptible to Hodgkin's lymphoma: the first includes men and women from 15 to 30 years old, and the second is mostly men over 50 years old.
Multiple studies on the occurrence of the disease have so far provided little information. Most experts tend to believe that infections, heredity, or malfunctions of the immune system serve as triggers for cell change. But there is no clear answer about the causes of the disease.
Distribution mechanism
The basic difference between lymphogranulomatosis and other types of lymphomas is as follows:
- Presence of binuclear giant Reed-Sternberg cells in the nodes.
- Presence of single-nuclear large Hodgkin cells.
- The inclusion of a large number of blood cells (erythrocytes, leukocytes, eosinophils, plasma cells, etc.) in the lymphoma.
There is another characteristic feature that defines Hodgkin's disease. Symptoms appear when the first lymph node is affected (on the neck, in the subclavian region, in the mediastinum), and metastases spread through the lymphatic and blood vessels, growing into organs adjacent to the foci - lungs, gastrointestinal tract, bone marrow, kidneys, etc.
Classification and stages of the disease
Specialists distinguish between two forms of the disease:
- Local - lymph nodes of one group are affected. There are forms of Hodgkin's disease - peripheral, pulmonary, skin, mediastinal, abdominal, nervous, etc.
- Generalized - metastases penetrate the spleen, kidneys, stomach, liver, skin.
Lymphogranulomatosis can occur both in acute form and in chronic course. The clinical classification of the disease is determined by four stages of development:
- First stage - the lesion affected one group of lymph nodes or one extralymphatic organ.
- Second stage - two or more groups of lymph nodes located on one side of the diaphragm are affected, or one extralymphatic organ along with regional lymph nodes.
- The third stage of the disease - the lymph nodes on both sides of the diaphragm are affected, one extralymphatic organ or the spleen can also be affected, or the lesion befalls them in a complex.
- Fourth stage - the disease has affected one or more internal organs (bone marrow, spleen, lungs, gastrointestinal tract, etc.), while the lymph nodes may or may not be involved in the disease.
Signs of the disease: swollen lymph nodes
At the initial stage, no one can diagnose Hodgkin's disease. Symptoms in adults and children do not give a clinical picture of the disease. Sometimes this happens by chance, during an ultrasound examination of the lungs, in this case, enlarged node structures will be visible in the picture. Only on laterstages, with obvious manifestations of pathology, a conclusion is made about the disease.
Manifestations of Hodgkin's disease:
- Increased lymph nodes in size.
- Systemic manifestations of the disease.
- Losses of internal organs and severe symptoms of failure processes in their functionality.
The first and constant symptom of the disease is an increase in one or more lymph nodes. The manifestation can occur anywhere - in the armpit, on the neck, in the groin. The patient does not experience any discomfort - there is no fever, the general state of he alth is normal. The nodes do not cause pain on palpation, they roll under the skin, resembling a dense ball, which gradually increases in size.
Lymphogranulomatosis in children
Children are also susceptible to Hodgkin's lymphoma (lymphogranulomatosis). Symptoms in children do not differ from the picture of the disease in adults, but with some additional manifestations:
- Excessive sweating, especially at night.
- Apathy, lethargy, decreased muscle tone.
- Headaches, rapid heartbeat (tachycardia).
- Stiff movement.
- Anemia, weight loss.
At the last stage of the disease "children's lymphogranulomatosis", the symptoms, the clinic of its manifestations do not differ from the same condition in adults.
Disease development
After the defeat of one of the nodes, the next stage is the spread of the diseaselymph nodes from the cervical region to the chest, pelvic organs and lower extremities. Deterioration of well-being begins at the moment when the swollen nodes begin to squeeze the organs adjacent to them, which leads to the following manifestations:
- Cough - is the result of compression of the bronchi and irritation of the receptors. Not treated with antitussives.
- Shortness of breath - occurs due to compression of the tissue of the lung, trachea or bronchi. The patient may experience a lack of air during intensive training, with an overgrown pathology and at rest.
- Swallowing disorder. Increasing in size, intrathoracic lymph nodes compress the esophagus. As a result, it is difficult for a person to swallow while taking solid food, and later liquid food.
- Disturbances in the work of the gastrointestinal tract - the growth of nodes leads to stagnation of food due to compression of individual segments of the intestine, which leads to bloating, diarrhea, constipation, etc. Tissue necrosis may also occur due to compression of blood vessels.
- Kidney dysfunction - occurs due to damage to the lumbar lymph nodes that put pressure on the kidney tissue. Since the kidneys are a paired organ, when acting on one of them, the patient will not feel changes, with a bilateral increase in pressure, renal failure occurs. This situation is extremely rare.
- Edema. Blood enters the heart from the superior and inferior vena cava. When squeezed by an enlarged node of the upper vein, swelling of the face, hands, neck occurs, and with pressure onlower vein edema observed in the legs, internal organs.
- Disturbances in the functioning of the nervous system occur as a result of compression of the spinal cord. With the defeat, the sensitivity and motor activity of the upper or lower extremities is impaired. Disorders in the work of the nervous system are extremely rare and the last diagnosis that is considered in such cases is lymphogranulomatosis.
Symptoms of damage to internal organs
Hodgkin's lymphoma, like all tumor processes, metastasizes into the tissues of any organ. The manifestations of the disease can be expressed in the following:
- Increased liver size. This symptom is observed in most of the patients with lymphoma. Malfunctions in the work of the organ begin from the moment when the overgrown lymph nodes displace he althy tissue.
- Enlargement of the spleen - this phenomenon overtakes up to 30% of patients with Hodgkin's disease already in the last stages of the disease. The development of pathology does not bring any pain to the patient and is asymptomatic.
- Violation of the process of hematopoiesis - occurs when pathological tissue grows in the cavities of the bones, while bone marrow cells are replaced by sprouted metastases. Pathology can lead to aplastic anemia (decrease in the production and renewal of blood cells). Children's lymphogranulomatosis is also manifested. Symptoms in adults, blood test and overall picture are identical.
- Lung damage occurs in 10 or 15% of cases of Hodgkin's disease. Symptoms appearwith the germination of altered tissue in the lungs. At the first stage, the patient does not feel any changes, and at the last stage, respiratory failure, shortness of breath, intense dry cough, etc.
- Violation of bone tissue is a severe type of lesion in which, in addition to inhibiting the activity of the bone marrow, bone tissue is disturbed. Tumor cells disrupt bone structures, complaints of pain are received, as a result of the slightest effort, pathological fractures occur. The most common sites of lesions are the vertebrae, pelvic bones, sternum.
- Skin itching occurs in a patient due to a significant increase in the blood of leukocytes, which break down and release active substances that irritate the skin.
The above list is the most important and frequent manifestations of the disease considered in the diagnosis of Hodgkin's disease. Symptoms of Hodgkin's lymphoma can appear in any organ and disrupt its work, structure and functionality.
Diagnosis
Determination of the disease is difficult due to the non-specificity of its manifestations, therefore, in most cases, lymphogranulomatosis is diagnosed only at a late stage of development. Symptoms, analysis of the general condition, and even clinical studies give a complete picture only after the discovery of compacted lymph nodes. It is extremely rare that only one node increases. At the stage of visual manifestation, there are usually already several lesions.
This disease is characterized by a late start of therapy, which sometimes does not lead to a positive outcome. In thatlies the main danger of Hodgkin's disease (lymphogranulomatosis). Symptoms, blood tests and other indicators lead the patient to inpatient treatment in the hematology department.
Diagnostic methods:
- Bone marrow puncture.
- Immunophenotyping of lymphocytes.
- Instrumental examination.
- Histology of lymph nodes for lymphogranulomatosis (symptoms).
- Blood is examined for biochemistry, its general analysis is also carried out.
Treatment
Modern medicine quite successfully treats Hodgkin's disease. Symptoms in adults, the analysis of all manifestations, the accuracy of diagnosis allow an experienced hematologist to build an effective treatment strategy, which includes:
- Chemotherapy (drug prescriptions).
- Radiotherapy.
- Surgical operations.
With a timely and correct diagnosis, adequate therapeutic measures, stable remission can be achieved in 80% of cases.
Prognosis of recovery is determined by the following factors:
- Stage of disease. The start of therapy at stages 1 and 2 of the development of the disease guarantees 90% of the onset of complete remission after a course of chemotherapy and radiotherapy. Starting treatment at stages 3 and 4 allows you to count on the success of treatment in 80% of cases.
- The defeat of internal organs by metastases often causes irreversible damage, treatment cannot restore structure and function.
- When the structure of the lymph nodes is affectedproper treatment can restore their functions partially or completely. With lymphoid depletion, reversible processes do not start. An aggravating circumstance is that the number of lymphocytes in the body will be reduced.
- Only 2-5% of cases of lymphogranulomatosis are resistant to any type of therapy.
- Relapses are observed in 10-30% of patients who have completed the entire course of chemotherapy and radiotherapy. The return of the disease is possible within a few months or years after the end of treatment.
