Internal Diseases and Therapy · MU Sofia

63. Hodgkin’s disease

Covers Hodgkin's lymphoma set against non-Hodgkin's lymphoma, starting with what lymphoma is and how the two main classes differ, with a comparison table. It then describes the four clinical stages, the typical presentation with painless cervical nodes and two age peaks, a note on managing a single raised node in primary care, diagnosis by biopsy, the histological subtypes with their percentages, differential diagnoses, and treatment by stage with the ABVD regimen.

Inside: 1 section · 2 labelled pictures · 2 tables · 15 flashcards · 5 min

Topic 63 of 139 in the MU Sofia syllabus for Internal Diseases and Therapy (Medicine, Years 4 and 5). The free AceMed note covers it in 1 section, about 575 words (5 min of reading), with 15 flashcards.

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  1. Hodgkin's disease

Hodgkin's disease

Hodgkin’s disease = Hodgkin’s lymphoma. I want to first talk a bit about both Hodgkins and non Hodgkins as I think this makes it easier to understand the two when they are placed side by side. After that I will consider each one in a bit more detail separately.

What is lymphoma? A lymphoma is simply disorders caused by malignant proliferation of lymphocytes, these accumulate in lymph nodes causing lymphadenopathy, but may also be found in peripheral blood or infiltrate organs.

There are two main classes of lymphoma:

  • Hodgkin's lymphomas
  • Distinctive neoplastic Reed-Sternberg giant cells
  • Generally affect axial lymph nodes (cervical, mediastinal, para-aortic)
  • Histological types, based on cellular morphology and cell infiltration in lymph node biopsy:
  • Classical
  • Nodular sclerosing
  • Lacunar cells
  • Mixed-cellularity subtype
  • Lymphocyte rich
  • Lymphocyte depleted
  • Nodular lymphocyte-predominant
  • Symptoms include swelling of lymph nodes, fatigue, fever, sweats and weight loss
  • Spread in in a stepwise fashion along lymph chains
  • Two peaks of incidence, adolescence and >50 y.o.
  • Non-Hodgkin's lymphoma
  • Can start in almost any part of the body (unlike Hodgkin's which starts in a single node)
  • Generally onset is older (over 65)
  • Many subtypes but generally
  • Aggressive
  • Indolent (slow development)

All types of lymphoma have four clinical stages:

  • Stage I - involvement of a single lymph node region
  • Stage II - involvement of two or more lymph node regions
  • Stage III - involvement of lymph node regions on both sides of diaphragm
  • Stage IV - disseminated involvement of one or more extralymphatic organs

Image: “Lymph node regions” by Lymph_node_regions.jpg : http://training.seer.cancer.gov/ss_module08_lymph_leuk/lymph_unit02_sec02_reg_lns.html derivati, Public domain, via Wikimedia Commons.

Right, now Hodgkin's lymphoma specifically. As mentioned there are two peaks of incidence, in young adults and the elderly. There is an increased incidence in males and a genetic component, with an increased risk if one has siblings with the disease.

The first symptom is often enlarged, painless, non-tender, ‘rubbery’ superficial lymph nodes, typically found in the cervical region (60% of the time), but also axillary or inguinal. Nodes may increase and decrease in size spontaneously, and 25% of cases have additional systemic symptoms. Other symptoms include mediastinal masses, which can be hard to identify (these can cause a mass effect) and retroperitoneal masses can develop with only very modest symptoms. All of these masses are usually painless but may be painful after drinking alcohol.

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