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Hodgkin's disease ´ëÀå°æ Á¤¸®

1. Reed-Sternberg cellÀÇ Ag expression: CD15, CD30

cf. CD15: lymphocyte predominant type¿¡¼­´Â ¹ßÇöµÇÁö ¾Ê´Â´Ù.

CD30: ¸ðµç Reed-Sternberg cell¿¡¼­ ¹ßÇöµÇ°í ¶ÇÇÑ ´Ù¸¥ ¸¹Àº ¼¼Æ÷¿¡¼­µµ ¹ßÇöµÈ´Ù.

2. RS cellÀÇ origin: germinal centerÀÇ B cell

3. disease activity¸¦ Æò°¡Çϴµ¥ °¡Àå À¯¿ëÇÑ °Ë»ç: ESR

±× ¿Ü> Cu, Ca, ALP, lysozyme, globulins, CRP, other acute phase reactants

4. staging¿¡ ÇʼöÀûÀÎ Lab: CBC, LFT, RFT, uric acid, ESR

5. Stagin laparotomyÀÇ ´ë»ó: RT ´Üµ¶ÀÇ Ä¡·á´ë»óÀΠȯÀÚ¿¡¼­ unsuspected abdominal

disease°¡ ÀÖÀ¸¸é Ä¡·á¹æÄ§ÀÌ ¹Ù²ð ¶§ ½ÃÇà

* ±Ý±â

i) bulky chest disease

ii) bulky abdominal involvement

iii) more than 4 nodal sites

iv) clinical stage III or IV

6. early stage¶óµµ combined modality treatment¸¦ ÇÏ´Â °æ¿ì = staging laparotomy°¡

Àǹ̾ø´Ù.

bulky mediastinal disease, significant B sx,

high-risk patient(mixed cellularity or lymphocyte-depletion histology, >40¼¼)

7. Hodgkin's diseaseÄ¡·á

I & IIA with good risk: RT alone without staging laparotomy

I & IIA with moderate risk: RT alone with staging laparotomy

combination CTx with RT

IIIA: combination therapy or ABVD alone

IIIB, IV: combination CTx alone ¡¾ RT

8. poor prognostic factors

1) early stage: male, multiple sites, ESR¡è, bulky mediastinal disease,

mixed cellularity or lymphocyte-depleted histology,

treatment with involved field RT

2) advanced stage : stage IV, B sx, inguinal node involvement, large mediastinal mass

male, bulky disease, anemia, leukocytosis, lymphocytosis

9. Ç×¾ÏÁ¦

1) ABVD: adriamycin/bleomycin/vinblastine/dacarbazine

ºÎÀÛ¿ë; cardiac toxicity, pulmonary fibrosis, myelosuppression(neutropenia)

2) MOPP : nitrogen mustard/oncovin/procarazine/prednisone

ºÎÀÛ¿ë: infertility, neuropathy, myelosuppression(thrombocytopenia)

secondary leukemia(MDS, acute leukemai, 5-10³âÈÄ)

10. °¡Àå ÈçÈ÷ µ¿¹ÝµÇ´Â paraneoplastic nephrotic syndrome? MCNS

12. HIV-associated Hodgkin's disease

NHLº¸´Ù ºóµµ°¡ ÈξÀ ÀûÀ¸³ª advanced stage, advanced course, extranodal involvement

°¡ ÈçÇϸç, Á¶Á÷µµ pleomorphic appearance¸¦ º¸¿© ÀÓ»ó¾ç»óÀÌ ³ª»Ú´Ù.

staging laparotomy´Â Àǹ̰¡ ¾ø´Ù.

routine PCP prophylaxis°¡ ÇÊ¿äÇϸç, CTxÁß¿¡ antiviral therapy°¡ ÇÊ¿äÇÏ´Ù.