Hodgkin's Lymphoma

Hodgkin's lymphoma is a malignancy derived from lymphocytes. It is characterized by orderly spread from one lymph node group to another, and development of constitutional symptoms in later stage disease (fevers, night sweats, chills). It has a bimodal distribution, occurring in ages 15-25 and 55+.

Hodgkin Lymphoma: A B cell lymphoma categorized by pathological analysis of the tumor cells as either classical or nodular lymphocyte predominant. Classic Hodgkin Lymphoma is divided into four subgroups: nodular sclerosis, mixed cellularity, lymphocyte rich, and lymphocyte depleted classical. The presence of Reed Sternberg cells is pathognomonic.

Epidemiology: Hodgkin Lymphoma is responsible for roughly 10% of all lymphomas and 0.6% of all cancers. The disease carries a bimodal distribution especially afflicting the young adults at an average of 20 or older adults at an average age of 65.

Risk Factors: While exact risk factors are unclear, there seems to be increased risk of developing Hodgkin Lymphoma with a history of various viruses including: EBV, CMV, HHV among others. Immunosuppression, including HIV, is also a risk factor.

Symptoms: Initial symptoms begin as painless peripheral lymphadenopathy especially involving the cervical region. This enlarged node is often nontender and has a rubbery consistency. Most patients will progress to experience systemic symptoms including fever, night sweats, and weight loss. These three ‘B symtpoms’ are more predominant with advanced disease.

Differential Diagnosis: Anaplastic Large Cell Lymphoma, Diffuse Large B Cell Lymphoma, Non-Hodgkin Lymphoma, Autoimmune Disease, HIV.

Investigations: A chest x-ray is ordered to search for mediastinal masses. A CT of the chest, abdomen, and pelvis is ordered to rule of disseminated disease. A MRI of the spine may be ordered if vertebral metastasis is suspected

Treatment: Treatment options are based off the stage of the disease so initial staging is of critical importance. Staging is done on a scale of one through four. Both radiotherapy and chemotherapy may be employed alone or together depending on the stage of the disease.

Case #1a. Multiple enlarged anterior mediastinal nodes in patient with Hodgkin's lymphoma.

Case #1b. Multiple enlarged retroperitoneal nodes in same patient.

Case #2. Mediastinal adenopathy with calcifications in this patient with Hodgkin's lymphoma.