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Lymphogranulomatosis

Lymphogranulomatosis (synonym: Hodgkin's disease, malignant granuloma) is a systemic malignant disease that is characterized by tumor-like growths in the lymph nodes, spleen, lungs, less often in other organs. Lymphogranulomatosis occurs at any age, somewhat more often among men than among women.

The etiology and pathogenesis of Hodgkin's disease has not yet been clarified.

Pathological anatomy : an increase in individual groups of lymph nodes, spleen, less often the liver. Histological examination of these organs reveals the proliferation of reticuloendothelial elements, and the appearance of Berezovsky-Sternberg giant cells with a multi-blade nucleus is especially characteristic.

lymphogranulomatosis
A patient suffering from a generalized form of Hodgkin's disease.

The first manifestation of Hodgkin's disease is usually an enlarged lymph nodes, often cervical (Fig.). Later other groups of nodes increase; they become dense, soldered to each other, but never suppurate or ulcerate. Enlarged spleen , liver . There is fever (usually undulating with one-, two-week alternations of periods of high and normal temperature), itching, weakness, weight loss, anemization. Overgrown mediastinal lymph nodes can squeeze the trachea and bronchi, recurrent nerve, esophagus , large blood and lymphatic vessels. This is manifested by difficulty in breathing, loss of voice due to paralysis of the vocal cords, impaired swallowing, regional blood and lymph circulation disorders, etc.

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The course of Hodgkin's disease is usually chronic, progressive, much less often subacute and acute. The death of patients occurs in 2-6 years from cachexia or dysfunction of vital organs due to compression of their enlarged lymph nodes.

At present, the early and rational use of radiation and chemical types of cytostatic therapy makes it possible to cause long-term remissions of Hodgkin's disease (up to several years), which significantly increases the life expectancy of patients (up to 10-15 years or more).

The diagnosis is made on the basis of a characteristic clinical picture and biopsy of the enlarged lymph node. X-ray examination reveals an increase in the lymph nodes of the mediastinum , and in some cases - damage to the lungs, gastrointestinal tract and bone system. In the study of blood, neutrophilic leukocytosis, hypochromic anemia, lymphocytic and thrombocytopenia (the latter can cause hemorrhagic complications), eosinophilia, and accelerated ESR are found .

It is necessary to differentiate lymphogranulomatosis with tuberculosis of the lymph nodes, reticulosarcoma , cancer metastases in the lymph nodes.

Treatment . In cases of limited lymphadenopathy, radiation therapy is performed (see), sometimes with their prior removal; with a generalized process - chemotherapy (dopane, degranol and others), always with constant monitoring of blood. Repeated blood transfusions , vitamins are shown: groups B, ascorbic acid, and in case of severe anemia, leuco- or thrombocytopenia , corticosteroids.

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Staying in the sun and physiotherapeutic procedures are contraindicated in patients with lymphogranulomatosis. See also Paragranulema .

Skin manifestations in lymphogranulomatosis may be specific and nonspecific. Specific manifestations include rash, during histological examination of which find changes characteristic of Hodgkin's disease and usually observed in the lymph nodes. Clinically, they are characterized by nodules and infiltrates in the form of plaques of various sizes (single and multiple), dense texture, as a rule, the color of normal skin, painless; erythroderma (see) or single tumors with a tendency to ulceration, resembling fungoid mycosis or lymphosarcoma.

Non-specific skin changes often simulate a variety of dermatoses . These include: persistent, painful, difficult to soothe skin itching, accompanied by excoriations (abrasions as a result of scratching) and lichenification (thickening of the skin and strengthening its relief); eruptions prруryginous (scab), urticarial (blisters), bullous (blistering), scarlet fever - and core-like, such as eczema , erythema multiforme, and others. Histologically reveal banal inflammatory infiltrate. As a result of trophic disorders, ichthyosiform changes develop: dry skin, peeling, hyperkeratosis (excessive keratinization of the epidermis), alopecia (see Alopecia ). There are also pigmentation disorders, shingles (see Herpes ). Perhaps the simultaneous existence of specific and nonspecific rashes. Skin changes in lymphogranulomatosis most often develop after lesions of the lymph nodes or simultaneously with them, but sometimes they can be the first symptom of the disease.

Lymphogranulomatosis (lymphogranulomatosis; synonym: Hodgkin's disease, malignant granuloma) is a serious common disease that occurs with tumor-like growths of lymph nodes, fever, itching of the skin and increasing cachexia.

Lymphogranulomatosis is a common disease; People of all ages are ill, but more often men are 30-50 years old. Life expectancy is different: with an acute course of 8–10 weeks, with a subacute - within a year, in cases of a chronic course - an average of 3-5 years, rarely more than 10-15 years.

Etiology and pathogenesis . The etiology of Hodgkin's disease has not yet been clarified. Numerous studies have not confirmed the concept of tuberculous etiology of lymphogranulomatosis that was widespread in the first three decades of the 20th century. Some authors emphasize the etiological role of many other pathogens. Based on the fact that the morphological essence of Hodgkin's disease is the development of granulation tissue, they try to treat Hodgkin's disease as an infectious-inflammatory process (M. A. Skvortsov). However, all the morphological variants encountered in Hodgkin's disease are also characteristic of diseases of a tumorous nature (I. V. Davydovsky).

In relation to the pathogenesis of Hodgkin's disease, there are also no generally accepted and definitive conclusions. More often lymphogranulomatosis is considered by analogy with leukemia as a peculiar blastomatous process. XX Vlados and N. A. Kraevsky relate lymphogranulomatosis to reticulosis, occurring with pronounced tumor growth. Lymphogranulomatosis can affect all organs and tissues.