Diagnostic Evaluationstaging

The diagnostic and staging evaluation of LP HL is similar to that previously described for classical HL. Diagnosis should be confirmed by an excisional or core needle biopsy, as fine needle aspirations frequently do not yield enough tissue to visualize the typical L&H cells surrounded by the polymorphic, nodular (or nodular and diffuse) infiltrate of reactive lymphocytes and histiocytes. CD20, CD57, CD15, CD30, and CD3 staining should be performed on all specimens of LP HL. The clinical history and physical examination should again focus on the presence of B symptoms, fatigue, evaluation of performance status, and examination of nodal sites. CBC with differential, LDH, BUN, creatinine, liver function tests, and staging imaging studies should also be performed. Staging according to the Ann Arbor system (Tables 72.3 and 72.4) is again recommended. CT scan of the chest/abdomen/pelvis (neck in selected cases) and bone marrow biopsy should be performed for staging purposes. 18F-FDG PET and 67Ga scintigraphy have not been extensively evaluated for patients with LP HL, but may prove to be useful for patients with equivocal CT scans. Finally, patients should again be counseled regarding fertility, smoking cessation, and risk of second malignancies, as therapy often consists of combination chemotherapy and/or radiotherapy as has been used in classical HL.

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