30. Malignant lymphomas. Classification, diagnostics and clinical features. Hodgkin’s disease. Classification, diagnostics, treatment possibilities

Page created on April 14, 2022. Not updated since.

For introduction to lymphomas, see pathology 2 topic 28.

Hodgkin lymphoma

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)
  • Immunodeficiency
  • 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)

Clinical features

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).

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