A 32-year-old man is diagnosed with Hodgkin’s lymphoma following a recent history of weight loss and night sweats. Computed tomography (CT) staging scan shows disease in the mediastinum bilaterally and some abdominal lymphadenopathy, but no evidence of disease in extranodal sites. The diagnosis was made on a lymph node biopsy. Bone marrow biopsy was normal.
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Hodgkin’s lymphoma has a bimodal age distribution with peak incidences occurring in the third and sixth decades. It classically presents with asymmetrical painless lymphadenopathy usually in the form of a single rubbery lymph node in the cervical, axillary or inguinal region that may become painful after alcohol ingestion. Disease spread to the mediastinal nodes may cause dyspnoea and superior vena cava obstruction. Approximately 20% of patients suffer systemic symptoms such as weight loss, sweating, fever, pruritis and general lethargy. These are known as “B” symptoms and are associated with a worse prognosis. Diagnosis is usually based on lymph node biopsy showing pathognomonic Reed–Sternberg cells (large malignant B-cells).
CT scanning is used to assess spread, and staging is by the Ann Arbor system (I=one node region involved, II=2+ ipsilateral regions, III=bilateral node involvement, IV=extranodal disease). The presence or absence of B symptoms is indicated in the staging by the suffix “A” (B symptoms absent) or “B” (B symptoms present).
Early-stage disease is may be managed with radiotherapy alone. In advanced and bulky disease the combination of radiotherapy and chemotherapy is often employed. The prognosis of Hodgkin’s lymphoma is usually good, with a 70% chance of cure even in late-stage disease. Increasing age indicates a poorer prognosis.
Thomas Hodgkin, British physician (1798–1866)
Ann Arbor is a city in the US state of Michigan, where the committee on Hodgkin disease staging classification met and revised the staging of lymphoma