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For introduction to lymphomas, see pathology 2 topic 28.
Introduction and epidemiology
Hodgkin lymphoma (HL) is a distinctive group of B-cell lymphoid neoplasms that are characterized by the presence of a special cell type called Reed-Sternberg cell (RS cells). It’s also characterised by the fact that the tumour consists of mostly inflammatory, responsive cells, and just a few cancerous cells. For this reason, HL has sometimes been called Hodgkin disease rather than lymphoma.
There’s a bimodal incidence peak, affecting either young adults (20 – 30) or elderly (50+). Hodgkin lymphoma is highly treatable and curable, even when disseminated.
Several risk factors are known:
- EBV infection (in 50%+ of cases)
- Autoimmune disease
There are five subtypes of HL, four of which are considered “classic Hodgkin lymphoma”:
- Classic Hodgkin lymphoma (95% of cases)
- Nodular sclerosis HL – most frequent subtype
- Mixed cellularity HL
- Lymphocyte rich HL
- Lymphocyte depletion HL – least frequent subtype
- Nodular lymphocyte predominant HL (5% of cases)
It presents with painless cervical or mediastinal lymphadenomegaly. “B symptoms” may also be present. The following findings are rare but very specific for HL:
- Pel-Ebstein fever – an intermittent high fever which has an abrupt onset and resolution and lasts 1 – 2 weeks at a time.
- Pain in lymph nodes when drinking alcohol
Hodgkin lymphoma causes secondary T-cell immune deficiency, which increases the risk for viral and fungal infections.
Diagnosis and evaluation
Lymph node biopsy showing Reed-Sternberg cells is diagnostic.
The basis of treatment is chemotherapy with or without involved field radiotherapy (IFRT). The most frequently used chemotherapy regimen is ABVD (Adriamycin, bleomycin, vinblastine, and dacarbazine).