The Differences between Lymphoma and Leukemia Type of Adult T-cell Leukemia

The difference between lymphoma type and leukemia type of adult T-cell leukemia (ATL) were analysed with 102 Japanese patients all positive for human T-cell leukemia virus type I (HTLV-I) antibody. They were classified into three groups on findings at first medical examination: lymphoma type cases, leukemia type cases, and mixed type (leukemia type plus lymphadeno-pathy) cases. Lymphoma type patients had several or more enlarged lymph nodes the largest of which was greater than 1 cm in diameter and with practically no abnormal lymphocytes (ATL. cells), which are characteristic of ATL, in the peripheral blood. Leukemia type patients had 10% or more ATL cells in the peripheral blood and had no detectablle lymphadenopathy Lymphoma type patients often complained of detectable lymphadenopathy, while leukemia type patients complained frequently of general fatigue and skin eruption. Mixed type patients more frequently had signs and symptoms which were characteristic of both types: lymphadenopathy and 10% or more ATL cells in the peripheral blood. Mixed type: ATL had a poorer prognosis than either lymphoma type or leukemia type. The median survival time was 3 months for mixed type patients, 10.5 months for lymphoma type patients, and 13.5 months for leukemia type patients. Complications and causes of death have also been touched upon. Clinicians are thus advised to consider ATL patients separately according to their clinical manifestations.     

Lymphoma-Associated Pancreatitis as a Presenting Manifestation of Immunoblastic Lymphoma

A 55 year old man presented with clinical signs and symptoms of subacute pancreatitis of unknown aetiology. Two weeks later, inguinal lymphadenopathy developed and a lymph node biopsy revealed a B cell immunoblastic lymphoma. Computerized tomography showed enlargement of the pancreas and immaging features consistent with pancreatitis. Administration of VACOP-B combination chemotherapy achieved complete resolution of the pancreatic mass and the enlarged lymph nodes. We consider this patient to have had lymphoma associated pancreatitis. This case represents a rare clinical presentation of lymphoma suggesting an alternative aetiology of subacute pancreatitis in some cases.     

高频彩超在浅表淋巴结定性诊断中的临床应用

目的：探讨高频彩超在定性诊断浅表淋巴结病变中的临床应用价值。方法：应用彩色多普勒超声观察经病理或临床证实的80例炎性、97例恶性患者的浅表淋巴结长短径、淋巴结门髓质部厚度、彩色血流特征。结果：炎性淋巴结纵径变异大,淋巴结门髓质部增厚,以中央血流为主;恶性淋巴结横径变异大,淋巴结门髓质部变薄或消失,以周边型血流为主。结论：高频彩超对浅表淋巴结定性诊断具有重要临床意义。     

Correlation between lymph node size on pathology and metastatic disease in right-sided colon cancer: A retrospective review

BackgroundIdentification of positive lymph nodes in colon cancer can significantly impact treatment. Few studies have examined the role of lymph node size in staging and prognosis. This study evaluated the relationship between lymph node size and lymph node metastases in right-sided colon cancer.MethodsRetrospective chart review was performed for patients undergoing colectomy for right-sided colon cancer from 2015 to 2020 across a single multi-hospital health system. Patients under age 18 or who did not have invasive adenocarcinoma upon pathological examination were excluded. Primary endpoints assessed lymph node size and lymph node metastases. 572 patients were stratified by lymph node size; lymph nodes ≥5 mm (n = 308) were characterized as enlarged.ResultsAll surgical specimens examined had adequate number of lymph nodes for staging. 33.9% of all specimens examined contained lymph node metastases. Patients with enlarged lymph nodes were significantly more likely to have lymph node metastases than those with normal-sized lymph nodes (p < 0.001). Enlarged lymph nodes were associated with advanced nodal staging.ConclusionsPatients with enlarged nodes were significantly more likely to have lymph node metastases than those with normal-sized lymph nodes. Further research to analyze these enlarged lymph nodes on radiologic imaging is warranted to determine the role of radiographic assessment of lymph node size during pre-operative staging.     

淋巴母细胞淋巴瘤21例临床病理分析

 【摘要】　目的　探讨淋巴母细胞淋巴瘤（LBL）的临床病理特征。方法　回顾性分析21例LBL患者组织形态学及免疫组织化学标志,并复习其临床资料。结果　21例患者年龄4～86岁,17例发生于淋巴结,余4例分别发生于鼻咽、乳腺、胸膜及纵隔。其中16例为T淋巴细胞LBL（T-LBL）,5例为B淋巴细胞LBL（B-LBL）。组织形态方面,肿瘤细胞中等大小, 呈弥漫分布, 染色质细腻或粉尘状,易见核分裂象。免疫组织化学方面,肿瘤细胞表达 TdT及CD99。结论　淋巴结肿大,镜下瘤细胞中等大小,核染色质细腻,免疫组织化学TdT阳性患者,尤其是青少年可确诊LBL。     

Cervical metastases from an occult primary site

Less than 5% of patients with metastatic cervical carcinoma will not have a detectable primary site despite a proper work-up. Recent aids for these diagnostic problems include fine needle aspiration and immunohistochemical panels to differentiate undifferentiated carcinoma from melanoma and/or lymphoma. CT scanning can suggest areas in the upper aerodigestive tract for biopsy and can be helpful in suggesting the pathology of the enlarged lymph nodes. EBV titers are often elevated when a nasopharyngeal carcinoma is small. Aggressive treatment of the occult primary patient with metastatic melanoma, thyroid cancer, and metastatic cancer presumed to arise from the skin of the head and neck or the mucous membranes of the upper aerodigestive tract is indicated as long-term survival is often achieved.     

恶性淋巴瘤受累淋巴结的全身螺旋计算机层析成像表现

目的探讨恶性淋巴瘤累及淋巴结的全身螺旋计算机层析成像（CT）表现及其解剖分布。方法回顾性分析89例诊治的淋巴瘤患者,其中霍奇金淋巴瘤（HL）12例,非霍奇金淋巴瘤（NHL）77例。所有患者均行颈部、胸部及全腹部CT直接增强扫描,记录所有病例肿大淋巴结分布、大小、密度及强化程度。结果HL组患者中普遍均匀强化9例（75．0％）,均匀强化伴坏死3例（25．0％）;NHL组中普遍均匀强化64例（83．1％）,均匀强化伴坏死13例（16．9％）,两组均匀强化情况比较差异无统计学意义（Fisher精确概率法,P=0．4461）。HL组中淋巴结呈融合状6例（50．0％）,不融合6例（50．0％）;NHL组中淋巴结呈融合状8例（10．4％）,不融合69例（89．6％）,两组比较差异有统计学意义（Fisher精确概率法,P=0．0028）。HL组患者常优势累及颈部及纵隔淋巴结,NHL组患者常优势累及颈部、纵隔及腹腔淋巴结,两组全身淋巴结累及优势分布差异无统计学意义（Fisher精确概率法,P=0．110）。结论全身螺旋CT扫描能很好的显示淋巴瘤患者全身淋巴结肿大的形态、部位及分布。     

通过增强CT评估肺癌患者纵隔转移淋巴结的分布及规律

目的:通过增强CT观察健康查体人群和肺癌患者的纵隔及肺内淋巴结变化情况,探讨不同类型、不同部位肺癌的淋巴结分布及可能的转移规律.方法:对2015年1月至6月进行增强CT检查的健康查体人群和病理确诊的肺癌患者,分别统计分析健康查体人群的纵隔及肺内淋巴结的大小及分布情况;不同类型、不同部位肺癌患者的纵隔及肺内淋巴结的大小及分布情况.结果:健康查体人群:人均淋巴结3.1个,以2、3、4、5区多见,右侧多于左侧,多为＜5 mm的小淋巴结,偶有5～10 mm的中等淋巴结,无＞10 mm的大淋巴结;肺癌患者纵隔淋巴结明显增多,以肿大淋巴结多见;小细胞肺癌淋巴结高于鳞癌、腺癌患者,常多达50枚以上;1-10区均可见大小不等淋巴结,肿大淋巴结以2、4、7、10区多见;无左右区别;与肺部肿瘤体积大小无明显相关;而鳞、腺癌患者纵隔淋巴结数目和大小与肿瘤大小、部位相关,肿瘤小者则淋巴结少,且肿大的淋巴结更少;肿瘤大者则纵隔各区均可见大小不等淋巴结,肿大淋巴结以4、7、10区常见.结论:健康查体人群可见淋巴结多为＜5 mm的小淋巴结;小细胞肺癌常见淋巴结数目多达50枚以上;鳞、腺癌的淋巴结变化情况和肿瘤大小、部位相关.结合淋巴结的数目与肿瘤大小、部位,能更好的对CT下肺癌患者的纵膈淋巴结进行全面探讨与评估.     

Female patient with a history of Hashimoto's thyroiditis,diagnosed with MALT lymphoma of both breasts

BACKGROUND: Mucosa-associated lymphoid tissue (MALT) lymphomas are a distinct subgroup of non-Hodgkin's lymphomas with preferable localization in the gastrointestinal tract. PATIENTS AND METHODS We describe the unusual case of a 48-year-old female patient, who was diagnosed with simultaneous MALT lymphoma of both breasts. Cervical, axillary and retroperitoneal lymph nodes were slightly enlarged, indicating an infiltration by the lymphoma. In her medical history the patient suffered from Hashimoto's thyroiditis. After 6 cycles of chemotherapy with CHOP regimen, the patient achieved complete remission. CONCLUSION: To our knowledge, this is the first case describing a patient with MALT lymphoma of the breast and a history of Hashimoto's thyroiditis. As patients suffering from autoimmune disorders, especially Sj?gren's syndrome and Hashimoto's thyroiditis, are at a higher risk to develop B-cell lymphoma, we assume that Hashimoto's thyroiditis favored development of MALT lymphoma in our patient.     

Lymph node staging by means of positron emission tomography is less accurate in non-small cell lung cancer patients with enlarged lymph nodes: analysis of 1,145 lymph nodes

BACKGROUND: Despite documented superiority of integrated positron emission tomography-computerized tomography (PET-CT) over computerized tomography (CT) in lymph node staging in non-small cell lung cancer, little is known about the sensitivity, specificity and accuracy of integrated PET-CT among enlarged lymph nodes. We sought to assess if PET-CT is uniformly accurate among enlarged and non-enlarged lymph nodes. METHODS: A retrospective review of 206 consecutive patients with histologically proven non-small cell lung cancer who underwent resection and/or mediastinoscopy in our centre over 30 months period was carried out. All these patients had pre-operative staging with integrated PET-CT as an adjunct to chest CT prior to resection and/or mediastinoscopy. Diabetic patients (BM>or=8.0 mmol/l) and those who received neo-adjuvant chemotherapy were excluded. The pathological results of all these cases were reviewed and correlated with those on CT and integrated PET-CT. RESULTS: The sensitivity, specificity, accuracy, positive and negative predictive values were higher in integrated PET-CT than CT alone in all lymph nodes, whether N1 or N2. When lymph nodes were stratified by size, the sensitivity of PET-CT was significantly higher among enlarged (>1cm) than non-enlarged (1cm) should be with caution as the specificity of PET-CT is lower and its ability to detect truly negative nodes become reduced. NSCLC patients with enlarged nodes by CT criteria who are PET-CT negative may require cervical mediastinoscopy to rule out metastatic spread to these nodes. Prospective studies are warranted.     

经支气管纵隔淋巴结针吸活检112例结果分析

目的:探讨经支气管针吸活检（transbronchial needle aspiration,TBNA）对肿大纵隔淋巴结诊断的应用价值。方法:回顾性分析2011年8月至2013年12月间在宝鸡市中心医院呼吸内科112例行胸部CT检查发现纵隔淋巴结肿大的病例,均行TBNA检查,总结穿刺结果及评价该技术的诊断价值和安全性。结果: 112例患者经TBNA检查7个部位共197组淋巴结,TBNA穿刺共410针,其中成功394针（96.1%）。95例恶性肿瘤患者中,TBNA总结果阳性90例（94.74%）,其中32例患者的TBNA结果是唯一病理学依据。32例患者行肺癌根治术,以术后淋巴结病理结果为参考,TBNA判断肺癌纵隔淋巴结分期诊断的敏感性、特异性、准确性、阳性预测值和阴性预测值分别是96.05%、100%、96.51%、100%、76.92%。22例TBNA阴性患者中,除6例经过TBNA确诊为结节病外,其余经开胸手术确诊,1例为淋巴瘤,4例为纵隔淋巴结转移癌,11例为阴性。在纵隔肿大淋巴结诊断中,敏感性、特异性和准确性分别为92.63%,100%和93.75%。小细胞肺癌TBNA的阳性率高于非小细胞肺癌,P＜0.01。直径≥3cm淋巴结TBNA的阳性率稍高,但差异无统计学意义。结论:TBNA对纵隔淋巴结诊断有很大帮助,且安全易行,值得基层医院临床推广应用。     

ORIGINAL ARTICLE: Enlarged hilar and mediastinal lymph nodes in chronic obstructive pulmonary disease

Introduction: To evaluate the frequency of enlarged hilar or mediastinal lymph nodes in patients suffering from chronic obstructive pulmonary disease (COPD). Methods: In a retrospective study, 89 patients with proven COPD were analysed. Exclusion criteria were history of malignant disease or clinical evidence of pneumonia. Prevalence, size, and localisation of enlarged lymph nodes were assessed by multi-slice computed tomography (MSCT) and correlated with the clinical stages following the GOLD classification as well as the MSCT findings of bronchitis and emphysema. Results: 44/89 (49%) of our patients showed enlarged lymph nodes. Lymph node enlargement was more often seen in the mediastinum (48%) than the hilar region (20%). The most common localisation of enlarged mediastinal lymph nodes was the regional station 7 following the ATS mapping (infracarinal). Patients with a stage I following the GOLD classification showed enlarged lymph nodes in 49% (18/37), stage II in 46% (12/26), stage III in 58% (7/12) and stage IV in 50% (7/14). These findings did not differ significantly (P > 0.05). Severe airway wall thickening (42/89) was significantly more often associated with an increase of nodal enlargement (64%) (P < 0.05). Conclusion: The present study demonstrates that enlarged hilar and mediastinal lymph nodes may occur in a rather high percentage of patients suffering from COPD, especially in those with the MSCT finding of severe bronchitis.     

纵隔镜检查在纵隔疾病诊断和肺癌分期中的应用

背景与目的:CT、纤维支气管镜等检查对某些纵隔疾病确诊仍十分困难;而准确地判定肺癌是否有纵隔淋巴结转移并对肺癌进行合理分期,对制定治疗方案和初步预测预后具有重要意义.本研究旨在探讨纵隔镜检查在纵隔疾病诊断和合并纵隔淋巴结肿大的肺癌分期中的应用价值和经验.方法:对16例CT等影像学检查发现有纵隔疾病的患者和14例术前经CT或PET、纤维支气管镜等检查诊断肺癌合并纵隔淋巴结肿大的患者进行纵隔镜检查和活检,行病理诊断.根据病理结果对肺癌进行分期.结果:未能确诊的纵隔疾病16例,经纵隔镜检查活检后获得病理确诊,分别为结节病5例,纵隔淋巴结结核3例,纵隔淋巴结炎性改变2例,淋巴瘤2例,胃肠道外胃肠道型恶性间质瘤1例,胸腺瘤1例,转移性小细胞癌1例,转移性腺癌1例;术前诊断肺癌并有纵隔淋巴结肿大的14例患者,经纵隔镜淋巴结活检,发现6例有纵隔淋巴结转移,8例无转移,后者经开胸手术,病理确诊为肺癌无纵隔淋巴结转移.14例患者经纵隔镜淋巴结活检均获得准确的肺癌分期;手术无严重并发症发生.结论:在纵隔疾病诊断和肺癌分期的应用方面纵隔镜检查是一种安全、准确的有效方法.     

EB病毒动态变化与淋巴瘤疗效的关系

目的 观察淋巴瘤患者血清中EB病毒(EBV)DNA的动态变化与临床疗效的关系.方法 对2015年9月至2017年8月安徽省肿瘤医院51例EBV阳性的淋巴瘤患者进行回顾性研究,对比EBV DNA含量的变化并通过乳酸脱氢酶(LDH)与肿大淋巴结的变化观察淋巴瘤的治疗效果.结果51例患者中,随EBV DNA升高,LDH亦升高者18例,随EBV DNA降低而LDH降低者23例,随EBV DNA降低而LDH升高者2例,随EBV DNA升高而LDH降低者8例,EBV DNA含量与LDH水平具有高度一致性(κ=0.609,P=0.000).51例患者中,随EBV DNA升高淋巴结增大者20例,随EBV DNA降低而淋巴结减小者22例,随EBV DNA降低淋巴结增大者3例,随EBV DNA升高淋巴结减小6例,EBV DNA含量与淋巴结大小变化具有高度一致性(κ=0.648,P=0.000).治疗过程中EBV DNA呈升高趋势的患者,其LDH平均值亦呈升高趋势;治疗过程中EBV DNA降低的患者,其LDH平均值亦降低.EBV阳性淋巴瘤患者LDH水平与EBV DNA含量呈正相关(r=0.627,P=0.000).结论EBV DNA及LDH动态检测可作为EBV阳性淋巴瘤患者治疗效果及随访评估指标.     

Primary splenic presentation of malignant lymphoma and related disorders. A study of 49 cases

The diagnosis of malignant lymphoma presenting as an initial splenic manifestation may go unrecognized as such when peripheral lymph nodes are not enlarged and when results of bone marrow biopsies are negative. Tissues from 49 patients, ranging in age from 15 to 78 years, in whom the original diagnosis of malignant lymphoma and related conditions was made at splenectomy, were classified as: diffuse small lymphocytic (20), diffuse large cell (11), diffuse small cleaved (5), diffuse large cell, immunoblastic (5), follicular small cleaved cell (3), and follicular mixed small cell and large cell (2). Two additional spleens, diagnosed as acute blastic leukemia, were initially confused with malignant non-Hodgkin's lymphoma by light microscopy. One patient presented with Hodgkin's disease confined to the spleen. For the non-Hodgkin's lymphoma group, parameters of age, sex, splenic weight (range, 226-4000 g), lymph node, bone marrow, or liver involvement did not adversely influence prognosis. Abdominal lymph nodes were positive in 31 of 37 patients having splenic hilar and/or abdominal lymph nodes available for review. Of 29 patients with adequate follow-up, 7 died of disease, 5 were free of disease at 3 years, 2 were free of disease at 5 years, 2 were alive with disease at 3 years, 4 were alive with disease at 5 years, and 9 died from second malignancies, unknown, or unrelated causes. Six of the 7 patients who died of lymphoma were classified as large cell (four diffuse large cell and two diffuse large cell, immunoblastic), with a mean 2-year survival. One patient died of leukemia. Those lymphomas classified as low grade behaved in an indolent fashion. The morphologic diversity of these cases emphasizes the need for the initial recognition and correct classification of lymphomas which present in the spleen, since survival is best determined according to histologic type.     

子宫内膜癌腹膜后淋巴结多点活检的临床意义

目的:探讨子宫内膜癌腹膜后淋巴结多点活检的临床意义.方法:对本院1990年1月～2000年12月初次手术时行腹膜后淋巴结活检的165例子宫内膜癌患者进行回顾性分析.比较各种临床病理因素的腹膜后淋巴结转移率,淋巴结转移与无转移及不同转移数目的5年生存率.结果:165例腹膜后淋巴结多点活检中,21例病理证实淋巴结转移,5年生存率23.81%,中位生存期30.20个月,与无淋巴结转移107例(随访5年以上),5年生存率66.36%,中位生存77.30个月,两者比较(P＜0.001).淋巴结转移≤3枚10例,5年生存率50.00%,中位生存42.10个月与淋巴结转移≥4枚11例,无5年生存,中位生存期21.30个月,两者相比(P＜0.001).经单因素分析,临床分期、组织类型、病理分级、肌层浸润深度、宫颈浸润、宫旁浸润及附件浸润、淋巴血管瘤栓与腹膜后淋巴结转移有关(P＜0.05),经多因素相关分析,此8个变量间比较,差异有显著性(P＜0.05).结论:腹膜后淋巴结多点活检能使手术病理分期更准确,是子宫内膜癌预后的重要因素之一,临床Ⅰ、Ⅱ期子宫内膜癌手术应常规行腹膜后淋巴结多点活检.     

Clinical and anatomical guidelines in pelvic cancer contouring for radiotherapy treatment planning.

BACKGROUND AND PURPOSE: Many observations on potential inadequate coverage of tumour volume at risk in advanced cervical cancer (CC) when conventional radiation fields are used, have further substantiated by investigators using MRI, CT or lymphangiographic imaging. This work tries to obtain three dimensional margins by observing enlarged nodes in CT scans in order to improve pelvic nodal chains clinical target volumes (CTVs) drawing, and by looking for corroborative evidence in the literature for a better delineation of tumour CTV. METHOD: Eleven consecutive patients (seven males, four females, mean age 62 years, range 43-78) with CT diagnosis of nodal involvement caused by pathologically proved carcinoma of the cervix (n = 2), carcinoma of the rectum (n = 2), carcinoma of the prostate (n = 2), non-Hodgkin lymphoma (n = 2), Hodgkin lymphoma (n = 1), carcinoma of the penis (n = 1) and carcinoma of the corpus uteri (n = 1) were retrospectively reviewed. Sixty CT scans with 67 enlarged pelvic nodes were reviewed in order to record the more proximal structures (muscle, bone, vessels, cutis or subcutis and other organs) to each enlarged node or group of nodes according to the four surfaces (anterior, lateral, posterior and medial) in a clockwise direction. RESULTS: A summary of the observations of each nodal chain and the number of occurrences of every marginal structure on axial CT slices is presented. Finally, simple guidelines are proposed. CONCLUSIONS: Tumour CTV should be based on individual tumour anatomy-mainly for lateral beams as it results from sagittal T2 weighted MRI images. Boundaries of pelvic nodes CTVs can be derived from observations of enlarged lymph nodes in CT scans.     

Treatment of a patient with a nodal peripheral T-cell lymphoma (Angioimmunoblastic T-cell lymphoma) with a human monoclonal antibody against the CD4 antigen (HuMax-CD4)

A patient with a CD4+ refractory peripheral T-cell lymphoma (PTL), subtype angioimmunoblastic T-cell lymphoma (AILD), was treated with a human monoclonal anti-CD4 antibody (HuMax-CD4) iv once weekly for 10 wk. Early during treatment all palpable enlarged lymph nodes disappeared. A decline of normal CD4+ T-cells in the blood mirrored the treatment effect. Shortly after stopping treatment the patient relapsed with new enlarged lymph nodes. This time no antitumor effect was seen when HuMax-CD4 treatment was reinstituted. No severe side effects were observed during the antibody treatment. This case report is the first describing that HuMax-CD4 has antilymphoma activity in PTL and is an interesting drug to study further in patients with CD4+ PTL.     

子宫颈癌腹主动脉旁淋巴结转移的诊断及治疗

子宫颈癌在女性恶性生殖系统肿瘤中的发生率居于首位,其中腹主动脉旁淋巴结（para-aortic lymph node PALN）转移与宫颈癌的治疗、预后密切相关。宫颈癌的淋巴转移途经多为宫颈旁、宫旁转移到闭孔、髂内外,再转移到髂总、骶前,最终汇集于腹主动脉旁淋巴结及（或）转移至锁骨上或腹股沟深淋巴结的阶梯式转移,但也存在不经过盆腔淋巴结的跳跃式转移。肿瘤的临床分期、有无宫旁浸润、盆腔淋巴结转移情况以及治疗前SCC 值等被认为是影响腹主动脉旁淋巴结转移的重要因素。术前评价淋巴结是否转移大多通过影像学诊断,CT通过显示淋巴结在横断面上的最大直径以及淋巴结内部密度改变来评价淋巴结是否转移,是目前应用最广泛的诊断方法,但其敏感性及准确性均低于PET 。肿大的腹主动脉旁淋巴结可以手术切除,特别是腹膜外腹主动脉旁淋巴结切除术以及腹腔镜下腹主动脉旁淋巴结切除术,由于其创伤小、对术后放疗影响小等优点逐渐发展起来,既能诊断,同时也有重要的治疗价值。腹主动脉旁淋巴结是宫颈癌治疗后最常见的复发部位之一,但被认为更多是局部病变,对复发淋巴结区域采取积极治疗仍可明显改善生存率。但初治时即存在腹主动脉旁淋巴结转移者,患者往往同时有远处转移或会在较短时间内出现远处转移,预后差。      

Actualités thérapeutiques dans le lymphome hodgkinien classique

Hodgkin lymphoma is a well-known clinico-pathological entity with a stable incidence among time accounting for 1200 new cases each year in France. The disease is one of the most curable cancer and occurs often in young patients with a median age at 33 years, the major clinical symptoms are lymph nodes mostly above the diaphragm (mediastinal and supra-clavicular). The diagnosis should be suggested with non-specific symptoms such as fever, night sweats, pruritus, weight-loss, lymph node, cough.. leading to prescribe routine exams like blood test with leucocyte count, erythrocyte sedimentation rate and chest Xray. Treatments always include chemotherapy and radiotherapy in localized disease and at a low dose only in involved fields. The usually good prognostic of Hodgkin lymphoma may not let us forget that there are still deaths in patients with refractory or early relapse of the disease. There is still an unmet need is these patients and the search for new drugs is essential.