Hodgkin Lymphoma

Snapshot

• A 15-year-old boy presents with fatigue and masses around his neck. The masses are small, mobile, and do not hurt. A few months ago, he had had an episode of infectious mononucleosis. He is referred for a lymph node biopsy, which comes back with positive Reed-Sternberg cells.

Introduction

• B-cell malignancy originating in lymphatic system
• Pathogenesis  
  • 50% of cases associated with EBV infection
  • Reed-Sternberg cells  
    • CD15+ and CD30+
• Epidemiology
  • bimodal distribution
    • young adulthood
    • > 55 years
  • male > female
• Types of Hodgkin lymphoma
  • nodular sclerosing
    • most common
  • mixed cellularity
  • lymphocyte-rich & predominant
    • especially in < 35-year-olds but also in older adults
  • lymphocyte-depleted
    • especially in > 60-year-olds
    • other systemic diseases
• Risk factors
• infectious mononucleosis with EBV

Presentation

• Symptoms 
  • constitutional (“B”) symptoms
    • fever
    • night sweats
    • weight loss
    • all caused by cytokines released from Reed-Sternberg cells
  • persistent painless lymphadenopathy
• Physical exam
  • nontender mass of localized, single group of nodes
    • rubbery
    • mobile
    • cervical
    • supraclavicular
• axillary

Evaluation

• Imaging for staging
• Lymph node biopsy
  • Reed-Sternberg cells
    • binucleate or bilobed, “owl-eyed” nuclei
  • mixed cellularity type
    • large inflammatory infiltrate with many eosinophils
  • nodular sclerosing type
• diffuse band-like fibrosis with lacunar spaces

Differential Diagnosis

• Non-Hodgkin lymphoma 
• AIDS-related lymphadenopathy
• Infection
• Breast cancer 
• Cat-scratch fever 

Treatment

• Based on staging
• Chemotherapy
• Radiation

Prognosis, Prevention, and Complications

• Prognosis
  • > 80% with treatment
    • better than non-Hodgkin lymphoma
    • lymphocyte-predominant = best prognosis
    • lymphocyte-deplete = worst prognosis
    • higher lymphocyte:RS cell ratio = better prognosis
• Complications
  • SVC syndrome
  • paraneoplastic syndromes
    • calctriol secretion causes hypercalcemia
  • from treatment
    • risk of solid tumors (breast, thyroid, and lung)
    • risk of premature coronary artery disease
    • risk of infection