 Hello everyone, welcome back to another session on dentistry and more. So today's topic is Hodgkin's lymphoma and oral pathology. So we are moving on to a new subject that is oral pathology. So we will be doing some videos on oral pathology. So today's video is of Hodgkin's lymphoma and this is a commonly asked question for University exam and also the Reed-Steenberg cell and one of the cell which is present in Hodgkin's lymphoma is popcorn cell. So can we can study both the cells under Hodgkin's lymphoma. So let's see what is exactly Hodgkin's lymphoma and its further details. So before moving on to Hodgkin's lymphoma, let's see what is hemopoietic malignancy. So hemopoietic malignancy is nothing but malignancy related to blood. So basically we have two types of hemopoietic malignancy. One is lymphoma and another one is leukemia. So lymphoma is a general term used for proliferations that arise as discrete tissue masses. Whereas leukemia, it is a neoplasm that present with widespread involvement of bone marrow and peripheral blood. So leukemia is very common. We have studied leukemia whereas lymphoma is a discrete mass whereas the leukemia which is present in bone marrow and blood. It is not very evident clinically but still it is a malignant condition whereas lymphoma it is very clinically evident because there will be masses present in the lymphatic system. So it is clinically evident condition. So these are the two hemopoietic malignancies. One is leukemia and one is lymphoma. So today's class is about Hodgkin's lymphoma. So lymphomas are malignant condition or tumors of lymphoid system and specifically lymphocytes or its precursor cells. So that is lymphoma or we can say that it is the cancer of lymphatic system. So it is the tumor of lymphoid system especially the lymphocytes and the precursor cells. So there are basically two types of lymphomas. So today's session we are dealing with only Hodgkin's lymphoma. There is a second one that is non-Hodgkin's lymphoma. So these are the two basic types. Now let's see what is exactly Hodgkin's lymphoma and its features. So these are a group of cancer which originate from lymphatic system. It was named after Thomas Hodgkin who first described it in 1832 and two other scientists who should remember one is Dorothea Reed and another one is Carl Steenberg. They first described the malignant cells of Hodgkin's lymphoma. This is known as Reed Steenberg cell. That's how this name came. These are two scientists name and this is the scientist Thomas Hodgkin Dorothea Reed and Carl Steenberg. So Hodgkin's lymphoma was the first cancer which could be successfully treated by radiation therapy and also by combination with chemotherapy. So this is a very treatable disease Hodgkin's lymphoma. It is one of the first cancer which can be treated using radiation therapy or in combination with the chemotherapy. Now let's see the details of Hodgkin's lymphoma. So when you write an exam paper especially a short essay or long essay you also you always should remember should be written in this format that is more subbeddings rather than bulking up in a single content you need to write more content that is more subbeddings like etiology, risk factors, pathology, clinical features, lab diagnosis, treatment and if you have any peculiar cells the details of cells its pictures and special names like also appearance. So that fetches you more marks rather than writing more about clinical features. You write two pages about clinical features and write nothing about its risk factors nothing about treatment. You won't get much marks. Always compress the answer and write under more and more subbeddings. So they look more on the left side that is the subbeddings not on the content mostly. So let's see one by one what is the etiology. Etiology is commonly unknown for this non-Hodgkin's lymphoma. Now let's see a little bit about epidemiology. So epidemiology we know how it is distributed and which age group and which gender it's all about epidemiology. So epidemiology is like it is bimodal distribution. So what is bimodal distribution? It is the disease the incidence of disease is peak. So it is peaked in two age groups that is 25 to 30 and greater than 55. We can say dental caries is a bimodally distributed disease because it is seen commonly among teenagers and also among adult people that is when rotex posture is there there is high chances of caries and also n age group that is 10 to 15 age groups. So dental caries is also a bimodal distribution disease just like Hodgkin's lymphoma and regarding the gender it is more commonly or slight predilection regarding with a male gender that is like 1.1 is to 1. So it may vary little bit country wise and it is very rare in less than 10 year group. It is peaked in 25 to 30 or more than 55. So that is about epidemiology etiology. Now let's move on to the risk factors. Risk factors actually there is no clear risk factors. The most common is Epstein war virus or HIV. It is also seen among people with woodwork farming and sometimes it is run-in family. Family history is a big factor. So the first degree relatives have 5-fold increases in risk of Hodgkin's lymphoma. So the first degree relatives of the already reported cases are at high risk and high socioeconomic status. So this disease is commonly seen in high socioeconomic status. It is one of the very rare disease which is seen in high social strata and it is prolonged use of human growth hormone also shown to be a risk factor growth hormone. So why etiology and risk factors are different? Etiology says that that causes we can say that streptococcus mutants causes dental caries. Risk factors is a attributing factor. It could contribute to that disease. So it can have more chances for that carry that particular disease. So these factors are just risk factors not etiological factors. So etiology and risk factors are different. Risk factors is more chances for caries not everyone will get the disease. Etiologies mostly most of the people will get that disease. So we can say that if suppose if we take dental caries we can say that high socioeconomic status is a risk factor for dental caries because these people eat more sugar and so there are chances of more caries. That is risk factor. Streptococcus mutants is a etiological factors mostly it is associated with dental caries. Now let us move on to the pathology. What happens is the lymphocytes are destroyed the immunity of the person is destroyed. So the immune cells it cannot synthesize immunoglobulin due to the dysregulation of nuclear factor. The DNA will be affected there will be dysregulation of nuclear factor and it cannot synthesize immunoglobulin and it looks like Reed-Steenberg cells that is will move to that later. So that is the pathology it is the immune system is disrupted that is the main thing happening in lymphoma. So how does it clinically appear? Clinically it looks like lymphadenopathy that is the masses concrete discrete masses that is painless non-tenter rubber type rubbery elastic discrete masses and it spreads mostly by chains of chain from one chain to another that is lymphatic chains spread from one chain to another and splenomegaly also is a clinical feature and the media steinal adenopathy. So clinical features are these one also cervical lymph nodes are 80 percentage cases cervical lymph nodes are involved whereas the media steinal involvement is about 50 percentage and also other symptoms like pleuritis nephrotic syndrome and immunohemolytic anemia hypercalcemia thromphocytopenia. So there are lots of conditions associated with Hodgkin lymphoma. Now let us move on to the lab diagnosis. How do we diagnose this? So first thing is the blood picture and also we can say that there is another symptoms like fever there will be fever and also trenching night sweats and weight loss will be there. So night sweats weight loss and fevers are other clinical features and I have not written everything I just want to give a brief picture of Hodgkin lymphoma not everything in detail it is not possible to write everything in this board. So I have skipped few so these are the clinical features now let us move on to lab diagnosis. When we take the blood picture that is complete blood count we can see neutrophilia snophilia and lymphocytopenia. So lymphocytes are affected so lymphocytes are less in number it is immature or it is disrupted and ESR is high ferritin count is high and the ultimate diagnosis is through biopsy. So while using biopsy technique we identify this Reed-Steenberg cell and confirming that Hodgkin lymphoma. So we can also take chest x-ray CT scan ultrasound PET scan and liver function test renal function test all we can use for diagnosis but ultimate thing is identifying histologically the Reed-Steenberg cell and the treatment from the the beginning I told you it is one of the first cancer which is treatable using chemotherapy and radiotherapy. So it is a very much treatable disease Hodgkin lymphoma can go for a chemotherapy and radiotherapy. So that is a brief picture of Hodgkin lymphoma now let us see what is exactly the Reed-Steenberg cell so from the name itself it is a combined effect of two scientists that is Dorothy Reed and Carl Steenberg. So these people identified the exclusive and the peculiar histological feature of this Hodgkin lymphoma that is Reed-Steenberg cell. It is nothing but a bi-nucleate bilobbed central nucleus with a large acidophilic nuclei surrounded by a clear halo. So you can see you closely look at it you can see a owl's head it looks like a owl's head and these two are owl's eyes it is a mirror image eyes that is why it is known as owl's eye appearance. Okay sometimes the question might come as just Reed-Steenberg cell so it is bi-nucleate bilobbed nucleus with acidophilic central nuclei which is surrounding by a clear halo it's known as owl's eye appearance. So it is most commonly greater than 45 micrometer in diameter and it is also known as mononuclear or Hodgkin cell, mummified cell or lacuna cell. So that is Reed-Steenberg cell. So these Reed-Steenberg cells of Hodgkin lymphoma are basically lymphocyte in nature and in the great majority of cases it is of B cell origin. So it is a B cell origin and lymphocyte in nature. Now let's see what is popconcel. So popconcel is nothing but it is a similar histological feature which is most commonly seen in nodular lymphocyte predominant Hodgkin's lymphoma. So NLPHL nodular lymphocyte predominant Hodgkin's lymphoma which is a very rare condition rare type of Hodgkin's lymphoma that is just 5 percentage of cases are with NLPHL. So this is the cells are known as popconcel because it looks like an exploded kernel of cone also known as L-Land H cell. So L-Land H cell is nothing but leukocytic and histocytic cell L-Land H cell which arises from centroblastic germinal center of B cells. So it is just like an exploded kernel of cone it is if in this condition that is NLPHL mostly the Reed-Steenberg cells will be absent instead of Reed-Steenberg cells the popcorn cells will be present. So both are coming under Hodgkin's lymphoma what is it? This is another variant of a rare variant of Hodgkin's lymphoma. So that's all about Hodgkin's lymphoma. So I talked about its the scientist names its etiology epidemiology risk factors pathology clinical features lab diagnosis treatment and in detail about Reed-Steenberg cell and popcorn cell. So don't forget these names Reed-Steenberg popcorn and Owl's eye. So these are the three things should be connected with Hodgkin's lymphoma. So never get confused you might study lots of cells Sang cell Reed-Steenberg cell popcorn cell so many types of many names are there in many conditions many syndromes many diseases. So chances of confusion is very high. So always connect and study that is Hodgkin's lymphoma is with Reed-Steenberg popcorn cell and Owl's eye appearance. So it simply might ask for a short note that is what is Owl's eye or Reed-Steenberg or popcorn cell. So if you have any doubts please comment in the section and if you would like to have any further lectures on any particular topic that also mentioned in the comment box. So I'll come up with a new topic on dentistry and more thank you.