Hodgkin Lymphoma

Hodgkin lymphoma (HL) is a clonal B-cell malignancy that resides predominantly in the lymphatic system. HL tends to develop within a single lymph node region and spreads in an orderly fashion to adjacent lymph nodes. A defining characteristic of HL is the presence of the Reed-Sternberg cell – a large cell with a bilobed nucleus and prominent nucleoli, giving the appearance of “owl’s eyes.”

There is a bimodal age distribution, peaking among patients in their 20s and in those greater than 50 years of age. HL commonly presents with painless lymphadenopathy (cervical, supraclavicular, and mediastinal). Other clinical manifestations include constitutional “B” symptoms (fever, drenching night sweats, and weight loss), pruritus, and hepatosplenomegaly. A suggestive symptom is pain in the affected lymph node after alcohol consumption. HL is associated with Epstein-Barr virus infection.

The diagnosis is made by excisional lymph node biopsy. Nodular sclerosing is the most common histologic type of HL. The staging evaluation includes CT scans (chest, abdomen, pelvis, and sometimes neck), PET scans, and sometimes bone marrow biopsy if advanced disease is suspected. The Ann Arbor system is used to stage HL with “A” and “B” modifiers. Stage A represents HL without symptoms (think: A = Asymptomatic). Stage B represents HL with constitutional symptoms, which is associated with a poorer prognosis (think: B = Bad). Treatment involves radiation therapy and/or combination chemotherapy.