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Hodgkin Lymphoma

Hodgkin's Disease

Hodgkin disease (Hodgkin lymphoma) is a type of lymphoma, that is marked by the presence of Reed-Sternberg cells. The 4 subtypes of Hodgkin lymphoma are: Nodular sclerosis Hodgkin disease, Mixed cellularity Hodgkin disease, Lymphocyte-rich Hodgkin disease and Lymphocyte-depleted Hodgkin disease.

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Hodgkin's disease, nodular sclerosis
Hodgkin's disease, nodular sclerosis
Hodgkin's disease, nodular sclerosis, Public Domain

Presentation

Hodgkin’s disease as a systemic ailment can affect multiple organ systems at the same time at any stage of the disease. The following system-wise symptomatology of Hodgkin’s disease is commonly seen in patients:

Splenomegaly
  • The presenting feature common in all cases was superficial lymphadenopathy followed by hepatomegaly in 17 (20%) cases and splenomegaly in 16 (19%). All the marrow aspirates were negative for infiltration.[ncbi.nlm.nih.gov]
  • Abdomen: Abdominal enlargement may be noted with splenomegaly or hepatomegaly. Extremities: Regional and disseminated lymphadenopathy may occur in the limbs due to lymph node involvement of the disease.[symptoma.com]
  • Hodgkin's lymphoma symptoms include night sweats, enlarged lymph nodes, splenomegaly, and back pain. Treatment entails radiotherapy or chemotherapy. Hodgkin's lymphoma prognosis is generally good, provided that the disease is detected early.[medscape.org]
  • The nodes may also feel rubbery and swollen when examined Splenomegaly: enlargement of the spleen occurs in about 30% of people with Hodgkin's lymphoma Hepatomegaly: enlargement of the liver, due to liver involvement, is present in about 5% of cases.[slideshare.net]
Cervical Lymphadenopathy
  • A 41-year-old man developed right cervical lymphadenopathy following renal transplantation 116 months previously for chronic renal failure of unknown origin. He had been taking cyclosporine, mycophenolate mofetil and prednisone.[ncbi.nlm.nih.gov]
  • Head and Neck: Most patient may present with painless cervical lymphadenopathy. Chest and Heart: Mediastinal lymph nodes may present as chest pain and dyspnea. Abdomen: Abdominal enlargement may be noted with splenomegaly or hepatomegaly.[symptoma.com]
Fever
  • We reported the case of a patient with stage IV Hodgkin's disease (involving the nodes and Liver) presenting with paraneoplastic fever and who subsequently developed hypothermia during chemotherapy administration.[ncbi.nlm.nih.gov]
  • A 30-year-old lady presented with fever, dry cough and weight loss for the preceding five months. Radiological investigations revealed a solitary nodular lesion in the lingula of the left lung.[ncbi.nlm.nih.gov]
  • Here we present a 52-year-old male complaining of epigastric pain and fever diagnosed as stomach adenocarcinoma and Hodgkin's lymphoma.[ncbi.nlm.nih.gov]
  • We report a case of an 18-year-old man, who presented with fever and was found to have pallor, generalised lymphadenopathy, hepatosplenomegaly, ascites and pedal oedema.[ncbi.nlm.nih.gov]
  • An 80-year-old man was admitted to hospital with low-grade fever, weight loss, asthenia and anorexia. Physical examination revealed generalised ichthyosis with palmoplantar hyperkeratosis.[ncbi.nlm.nih.gov]
Weight Loss
  • A 30-year-old lady presented with fever, dry cough and weight loss for the preceding five months. Radiological investigations revealed a solitary nodular lesion in the lingula of the left lung.[ncbi.nlm.nih.gov]
  • An 80-year-old man was admitted to hospital with low-grade fever, weight loss, asthenia and anorexia. Physical examination revealed generalised ichthyosis with palmoplantar hyperkeratosis.[ncbi.nlm.nih.gov]
  • Nine months after transplantation, she presented with anorexia, asthenia and weight loss. Cutaneous Kaposi's sarcoma and a Hodgkin disease were diagnosed. MMF was discontinued and cyclosporine A was switched to sirolimus.[ncbi.nlm.nih.gov]
  • A 25 years old lady, 34 weeks primigravida was referred from the Emergency Department to the Medical Unit Khyber Teaching Hospital-MTI, Peshawar with four weeks of fever, progressive jaundice, pruritus, night sweats and weight loss.[ncbi.nlm.nih.gov]
  • Asymptomatic (A) - No fever, night sweats, or weight loss. Symptomatic (B) - Symptoms include fever, night sweats, or weight loss. Diagnosis The definitive way to diagnose Hodgkin's disease is via biopsy of the suspected lymph node.[news-medical.net]
Pain
  • We reported a 14-year-old boy initially evaluated with pain localized at the left ilium.[ncbi.nlm.nih.gov]
  • Here we present a 52-year-old male complaining of epigastric pain and fever diagnosed as stomach adenocarcinoma and Hodgkin's lymphoma.[ncbi.nlm.nih.gov]
  • We describe the case of a 59-year-old Caucasian male who presented to the outpatient clinic with intractable hiccups, upper abdominal pain, repeated bouts of vomiting, and stiff neck.[ncbi.nlm.nih.gov]
  • During the second cycle of chemotherapy, she experienced sudden profound bone pain in the lumbosacral region associated with elevated levels of lactate dehydrogenase (LDH), fibrin degradation products (D-Dimer), and alkaline phosphatase as well as pancytopenia[ncbi.nlm.nih.gov]
  • Bone Pain One place Hodgkin's lymphoma can metastasize is bone marrow, and sometimes bone pain, a limp or a spontaneous fracture is the clue that Hodgkin's has recurred.[livestrong.com]
Fatigue
  • On the symptom scales, higher mean scores, exceeding 10 points, were obtained for the scales "Fatigue" and "Sleep".[ncbi.nlm.nih.gov]
  • A 28-year-old man with a history of Hodgkin disease in remission had fatigue, pyrexia, and a raised ESR. His F-18 FDG PET/CT, performed to exclude lymphoma recurrence, demonstrated FDG-avid lymphadenopathy and increased FDG uptake in his spleen.[ncbi.nlm.nih.gov]
  • A 60-year-old woman presented to her primary care physician with fatigue and anemia. Laboratory evaluation revealed a hemoglobin level of 9.8 g/dL and an erythrocyte sedimentation rate (ESR) of 64 mm/hour.[ncbi.nlm.nih.gov]
  • Commonly reported physical consequences of HD include fatigue, anticipatory nausea and vomiting, and cognitive problems that lasted several years after treatment completion, as well as long-term life-threatening adverse effects including secondary cancers[ncbi.nlm.nih.gov]
  • Enduring fatigue results for patients receiving these therapies were not observed. Implications for cancer survivors These data provide comprehensive 7-year follow-up vitality information, an important symptom for early-stage lymphoma survivors.[ncbi.nlm.nih.gov]
Lymphadenopathy
  • Although all the radiological examinations suggested an osseous anomaly, histopathologic evaluation of the pelvic lymphadenopathies provided definite diagnosis of the disease.[ncbi.nlm.nih.gov]
  • We report a case of an 18-year-old man, who presented with fever and was found to have pallor, generalised lymphadenopathy, hepatosplenomegaly, ascites and pedal oedema.[ncbi.nlm.nih.gov]
  • His F-18 FDG PET/CT, performed to exclude lymphoma recurrence, demonstrated FDG-avid lymphadenopathy and increased FDG uptake in his spleen. A day later he developed the generalized rash of acute varicella infection.[ncbi.nlm.nih.gov]
  • A 41-year-old man developed right cervical lymphadenopathy following renal transplantation 116 months previously for chronic renal failure of unknown origin. He had been taking cyclosporine, mycophenolate mofetil and prednisone.[ncbi.nlm.nih.gov]
  • Computed tomographic (CT) scan of the abdomen and subsequent positron emission tomographic (PET) scan revealed extensive lymphadenopathy. Biopsy of periaortic lymph nodes revealed Hodgkin's disease of the mixed cellularity type.[ncbi.nlm.nih.gov]
Dyspnea
  • We report the case of a 16 years old female who presented with 6 months history of dry cough, hemoptysis, dyspnea, dysphagia and dysphonia. The chest radiography showed a mediastinal and pulmonary opacity.[ncbi.nlm.nih.gov]
  • On clinical examination, this dog presented with nonproductive dry cough, serous nasal discharge, dyspnea, and lack of appetite. Radiography showed a consolidated lesion in the left cranial lung lobe.[ncbi.nlm.nih.gov]
  • Chest and Heart: Mediastinal lymph nodes may present as chest pain and dyspnea. Abdomen: Abdominal enlargement may be noted with splenomegaly or hepatomegaly.[symptoma.com]
  • Symptoms may include: Painless swelling of the lymph nodes in the neck, underarm, groin, and/or chest Difficulty breathing (dyspnea), coughing, or chest pain due to enlarged nodes in the chest Fever Night sweats Tiring easily (fatigue) Weight loss/decreased[stanfordchildrens.org]
Dry Cough
  • We report the case of a 16 years old female who presented with 6 months history of dry cough, hemoptysis, dyspnea, dysphagia and dysphonia. The chest radiography showed a mediastinal and pulmonary opacity.[ncbi.nlm.nih.gov]
  • A 30-year-old lady presented with fever, dry cough and weight loss for the preceding five months. Radiological investigations revealed a solitary nodular lesion in the lingula of the left lung.[ncbi.nlm.nih.gov]
  • On clinical examination, this dog presented with nonproductive dry cough, serous nasal discharge, dyspnea, and lack of appetite. Radiography showed a consolidated lesion in the left cranial lung lobe.[ncbi.nlm.nih.gov]
Hemoptysis
  • We report the case of a 16 years old female who presented with 6 months history of dry cough, hemoptysis, dyspnea, dysphagia and dysphonia. The chest radiography showed a mediastinal and pulmonary opacity.[ncbi.nlm.nih.gov]
  • […] period of 1-2 wk) A large mediastinal mass may produce chest pain, cough or shortness of breath Pruritus Nodal pain, especially if preceded by drinking alcohol may occur in less than 10% of patients but is characteristic of Hodgkin lymphoma Rarely, hemoptysis[learningradiology.com]
  • […] the classic Pel-Ebstein fever is observed (high fever for 1-2 wk, followed by an afebrile period of 1-2 wk) Chest pain, cough, shortness of breath, or a combination of those may be present due to a large mediastinal mass or lung involvement; rarely, hemoptysis[emedicine.medscape.com]
Pleural Effusion
  • Pericardial and pleural effusions developed in one patient after cycles 4 and 5 of GV, consistent with gemcitabine-induced radiation recall. There were no toxic deaths.[ncbi.nlm.nih.gov]
  • effusion from lymphatic obstruction About 1/3 have pleural effusions Effusion usually does not contain malignant cells Pneumonic form Diffuse nonsegmental infiltrate (pneumonic type) Massive lobar infiltrates (30%) Homogeneous confluent infiltrates with[learningradiology.com]
Stridor
  • While pulmonary involvement in Hodgkin's disease can present as a non-resolving pneumonia, the clinical clues of dyspnoea, stridor and wheeze point to a possible endobronchial involvement.[ncbi.nlm.nih.gov]
Loss of Appetite
  • Signs may include fever, fatigue, night sweats, itching, loss of appetite, and weight loss. Painless swelling in the lymph nodes in neck, armpits, and groin also may occur.[publichealth.va.gov]
  • […] of appetite Relentless fever Night sweats Staging is a process in which the extent of cancer spread is determined - this is useful in indicating what level of treatment will be most appropriate.[news-medical.net]
  • Symptoms may include any of the following: Feeling very tired all the time Fever and chills that come and go Itching all over the body that cannot be explained Loss of appetite Drenching night sweats Painless swelling of the lymph nodes in the neck, armpits[ufhealth.org]
  • Symptoms include painless swelling of the lymph nodes in the neck, armpits, or groin fever and chills night sweats weight loss loss of appetite itchy skin doctors can diagnose hodgkin disease with a biopsy.[icd10data.com]
Nausea
  • Commonly reported physical consequences of HD include fatigue, anticipatory nausea and vomiting, and cognitive problems that lasted several years after treatment completion, as well as long-term life-threatening adverse effects including secondary cancers[ncbi.nlm.nih.gov]
  • Apart from pain, nausea, vomiting, and lack of appetite can be debilitating side effects of chemotherapy. Nausea and vomiting are two major reasons patients turn to medical cannabis.[herb.co]
  • These medicines are extremely effective in killing off the cancer cells, but they do have side effects, including nausea, vomiting , hair loss , tiredness, and lowering of the blood counts.[kidshealth.org]
  • Abdominal pain, nausea and vomiting, constipation, frequent urination, muscle weakness or aches are symptoms listed by MayoClinic.com as easy-to-spot signs of hypercalcemia.[livestrong.com]
Hiccup
  • We describe the case of a 59-year-old Caucasian male who presented to the outpatient clinic with intractable hiccups, upper abdominal pain, repeated bouts of vomiting, and stiff neck.[ncbi.nlm.nih.gov]
Chest Pain
  • Symptoms The symptoms of Hodgkin's disease include the following: Painless swelling of the lymph nodes commonly in the neck, groin, or underarms Painful lymph nodes following alcohol consumption Itchy skin (Pruritis) Persistent tiredness Chest pain and[news-medical.net]
  • The Mayo Clinic reported that other symptoms include abdominal pain or swelling, chest pain, fatigue, fever, night sweats, and weight loss.[medicaldaily.com]
  • Chest and Heart: Mediastinal lymph nodes may present as chest pain and dyspnea. Abdomen: Abdominal enlargement may be noted with splenomegaly or hepatomegaly.[symptoma.com]
  • “B” symptoms are present in 40% Unexplained weight loss Fever Night sweats Intermittent fever in about 35% of cases Infrequently, Pel-Ebstein fever (high fever for 1-2 wk followed by an afebrile period of 1-2 wk) A large mediastinal mass may produce chest[learningradiology.com]
  • pains, or breathing problems if there are swollen lymph nodes in the chest Excessive sweating Pain or feeling of fullness below the ribs due to swollen spleen or liver Pain in lymph nodes after drinking alcohol Skin blushing or flushing Symptoms caused[ufhealth.org]
Heart Failure
  • Medscape Education Oncology , August 2017 Risk of Heart Failure in Survivors of Hodgkin Lymphoma: Effects of Cardiac Exposure to Radiation and Anthracyclines In patients with Hodgkin lymphoma, the risk for heart failure increases with increasing radiation[medscape.org]
  • Aortic Stenosis/Outflow Aortic disease Atrial Fibrillation Bleeding Risk Coronary Artery Disease ECG Echocardiography Heart Failure Hypertension Invasive Hemodynamics Miscellaneous Mitral Regurgitation Mitral Stenosis PCI and Cardiac Surgery Pre-operative[qxmd.com]
  • However MOPP is used for individuals who are at risk for heart failure. The chemotherapeutic drugs may be injected into a vein or muscle, or taken orally, as a pill or liquid.[encyclopedia.com]
Hepatosplenomegaly
  • We report a case of an 18-year-old man, who presented with fever and was found to have pallor, generalised lymphadenopathy, hepatosplenomegaly, ascites and pedal oedema.[ncbi.nlm.nih.gov]
  • Physical examination revealed a cachectic male with pallor, with enlarged left supraclavicular Virchow's lymph node and hepatosplenomegaly.[ncbi.nlm.nih.gov]
  • B symptoms were observed in 57.6% of the patients, hepatosplenomegaly--in 30.6%, anemia--in 27.1% and elevated serum lactat dehydrogenase (LDH)--in 41.2%. The overall treatment consisted of both EFRT and CHT.[ncbi.nlm.nih.gov]
  • Hepatosplenomegaly: the enlargement of both the liver and spleen caused by the same disease.[slideshare.net]
Hepatomegaly
  • The presenting feature common in all cases was superficial lymphadenopathy followed by hepatomegaly in 17 (20%) cases and splenomegaly in 16 (19%). All the marrow aspirates were negative for infiltration.[ncbi.nlm.nih.gov]
  • Abdomen: Abdominal enlargement may be noted with splenomegaly or hepatomegaly. Extremities: Regional and disseminated lymphadenopathy may occur in the limbs due to lymph node involvement of the disease.[symptoma.com]
  • The nodes may also feel rubbery and swollen when examined Splenomegaly: enlargement of the spleen occurs in about 30% of people with Hodgkin's lymphoma Hepatomegaly: enlargement of the liver, due to liver involvement, is present in about 5% of cases.[slideshare.net]
  • […] inguinal area (groin, 6-20%) Involvement of the Waldeyer ring (back of the throat, including the tonsils) or occipital (lower rear of the head) or epitrochlear (inside the upper arm near the elbow) areas is infrequently observed Splenomegaly and/or hepatomegaly[emedicine.medscape.com]
Bone Pain
  • During the second cycle of chemotherapy, she experienced sudden profound bone pain in the lumbosacral region associated with elevated levels of lactate dehydrogenase (LDH), fibrin degradation products (D-Dimer), and alkaline phosphatase as well as pancytopenia[ncbi.nlm.nih.gov]
  • Bone Pain One place Hodgkin's lymphoma can metastasize is bone marrow, and sometimes bone pain, a limp or a spontaneous fracture is the clue that Hodgkin's has recurred.[livestrong.com]
  • […] mediastinal mass may produce chest pain, cough or shortness of breath Pruritus Nodal pain, especially if preceded by drinking alcohol may occur in less than 10% of patients but is characteristic of Hodgkin lymphoma Rarely, hemoptysis Rarely, back or bone[learningradiology.com]
  • You will need to tell your healthcare team if you have new or worsening: Swelling of lymph nodes in the neck, armpits, or groin Night sweats Shortness of breath Loss of appetite Deep bone pain Signs of infection, including chills or muscle aches Ask questions[summitmedicalgroup.com]
  • pain may rarely occur A family history is also helpful; in particular, nodular sclerosis Hodgkin lymphoma (NSHL) has a strong genetic component and has often previously been diagnosed in the family Physical Examination Physical examination findings in[emedicine.medscape.com]
Back Pain
  • Magnetic resonance imaging (MRI) is a non-invasive and helpful tool when detecting spinal and paraspinal lesions and we emphasize that spinal MRI should be performed without delay if there is persistent back pain or sciatica.[ncbi.nlm.nih.gov]
  • A case report of a 28-year-old woman who presented with back pain and progressive weakness in the lower extremities as a result of spinal cord compression from Hodgkin's disease of the thoracic vertebrae.[ncbi.nlm.nih.gov]
  • Select as many as you like ADHD Abuse Acne Adderall Adoption and Fostering Agoraphobia Alcohol Alzheimers Ambien Amputee Anemia Anger Management Anorexia Anxiety Arthritis Asperger Syndrome Asthma Ativan Autism Back Pain Bedwetting Binge Eating Bipolar[hodgkins-lymphoma.supportgroups.com]
  • Hodgkin's lymphoma symptoms include night sweats, enlarged lymph nodes, splenomegaly, and back pain. Treatment entails radiotherapy or chemotherapy. Hodgkin's lymphoma prognosis is generally good, provided that the disease is detected early.[medscape.org]
Osteoporosis
  • Lymphedema Lyrica Marijuana Medicaid Medicare Menopause Metformin Meth Methadone Migraine Military Military Family Miscarriage Moms Morphine Multiple Sclerosis Naproxen Narcissist Narcolepsy Neurontin Non Hodgkins Lymphoma Nutrition OCD Obesity Online Dating Osteoporosis[hodgkins-lymphoma.supportgroups.com]
  • Bone thinning (osteoporosis) may occur with steroid treatments such as prednisone. Decrease in heart function may occur with the use of anthracycline drugs (such as doxorubicin).[mountsinai.org]
Night Sweats
  • A 25 years old lady, 34 weeks primigravida was referred from the Emergency Department to the Medical Unit Khyber Teaching Hospital-MTI, Peshawar with four weeks of fever, progressive jaundice, pruritus, night sweats and weight loss.[ncbi.nlm.nih.gov]
  • Asymptomatic (A) - No fever, night sweats, or weight loss. Symptomatic (B) - Symptoms include fever, night sweats, or weight loss. Diagnosis The definitive way to diagnose Hodgkin's disease is via biopsy of the suspected lymph node.[news-medical.net]
  • B symptoms (fevers, night sweats, weight loss) occur in approximately 30% of patients; more common in advanced disease. Imaging, preferably PET-CT, essential to determine extent of disease. Biopsy is necessary to confirm diagnosis.[bestpractice.bmj.com]
  • No fever, night sweats, or weight loss. Symptomatic (B). Symptoms of fever, night sweats, or weight loss. How is Hodgkin lymphoma treated in a child? Most children with Hodgkin lymphoma are treated successfully and cured.[urmc.rochester.edu]
  • […] lymphocyte predominant Hodgkin disease (NLPHD) Distinct entity -- unique clinical features, different treatment Clinical Findings Most patients with disease above diaphragm are asymptomatic “B” symptoms are present in 40% Unexplained weight loss Fever Night[learningradiology.com]
Pruritus
  • All trials failed and her pruritus remained at level 8 of 10 most of the time. In April 2006, she started on thalidomide, 200 mg at night. The pruritus significantly improved to a level of 3 of 10 but did not disappear completely.[ncbi.nlm.nih.gov]
  • A 25 years old lady, 34 weeks primigravida was referred from the Emergency Department to the Medical Unit Khyber Teaching Hospital-MTI, Peshawar with four weeks of fever, progressive jaundice, pruritus, night sweats and weight loss.[ncbi.nlm.nih.gov]
  • These generalized symptoms of lymphoma include: Poor appetite Weight loss Night sweats Fever Fatigue or sense of ill-feeling Itching (pruritus) is another symptom in patients with Hodgkin disease; itching can be mild or severe, and tends to occur more[curesearch.org]
  • The medical term for itching without a rash or irritation of the skin is pruritus without excoriation, and it is another signal of lymphatic inflammation, but it can also be a sign of liver involvement.[livestrong.com]
Excoriation
  • The medical term for itching without a rash or irritation of the skin is pruritus without excoriation, and it is another signal of lymphatic inflammation, but it can also be a sign of liver involvement.[livestrong.com]
Neck Mass
  • She developed a discharging lateral neck mass with progressive increase of the mediastinal mass. She subsequently required a neck exploration and mediastinoscopy.[ncbi.nlm.nih.gov]
Neck Swelling
  • A 23-year-old Asian lady presented with a hard indurated midline neck swelling of 2 months duration without any upper aerodigestive tract or systemic symptoms of note. Her inflammatory markers were elevated and she was commenced on antibiotics.[ncbi.nlm.nih.gov]
Amenorrhea
  • RESULTS: Six months following the end of chemotherapy, the menstrual cycle resumed in all Group A patients and in four Group B patients who had amenorrhea. Eight Group B patients had regular menses during and after chemotherapy.[ncbi.nlm.nih.gov]
  • See Also Amenorrhea; Bone marrow transplantation ; Childhood cancers; Fertility and cancer; Imaging studies; Immune response Resources BOOKS Dollinger, Malin, et al. Everyone's Guide to Cancer Therapy. Kansas City : Andrews McKeel Publishing, 1997.[encyclopedia.com]
  • Secondary amenorrhea after Hodgkin's lymphoma is influenced by age at treatment, stage of disease, chemotherapy regimen, and the use of oral contraceptives during therapy: a report from the German Hodgkin's Lymphoma Study Group.[emedicine.medscape.com]
Peripheral Neuropathy
  • Peripheral neuropathy can also cause problems to muscles, the digestive system, and body organs including the heart.[mountsinai.org]
Insomnia
  • Healthy Sex Heart Attack Heart Disease Heartburn Hepatitis C Heroin Herpes High Blood Pressure High Cholesterol Hives Hoarding Hodgkins Lymphoma Huntingtons Disease Hyperthyroidism Hypothyroidism Hysterectomy Incest Survivors Infertility Infidelity Insomnia[hodgkins-lymphoma.supportgroups.com]

Workup

The following diagnostic procedures are used to verify and assess cases of Hodgkin’s disease in suspected individuals:

  • Chest X-ray
  • CT scan of chest, pelvis and abdomen
  • Complete blood count
  • Alkaline phosphatase, LDH, albumin, liver function test, calcium
  • BUN and creatinine
  • Lymph node biopsy
  • MRI and PET
  • Bone marrow biopsy
Mediastinal Mass
  • She developed a discharging lateral neck mass with progressive increase of the mediastinal mass. She subsequently required a neck exploration and mediastinoscopy.[ncbi.nlm.nih.gov]
  • FENO resulted significantly related to the mediastinal mass maximum diameter (p 0.009) and was significantly higher in patients with as compared to those without bulky mediastinal disease (38.7 ppb, CI 95% 19.3-58.0, versus 20.7 ppb, CI 95% 16.6-24.7;[ncbi.nlm.nih.gov]
Pericardial Effusion
  • Whole lung and heart irradiation was also planned due to bilateral pleural and pericardial effusions. The prescribed radiation dose was 21 Gy to the PTV and 10.5 Gy to the whole lung and heart. Target coverage was comparable for both plans.[ncbi.nlm.nih.gov]
Anergy
  • This is not the usual immunophenotype and cytokine production pattern of Th1, Th2 or Th0 cells and may be a reflection of anergy.[ncbi.nlm.nih.gov]
Enlargement of the Liver
  • Symptoms Painless local or disseminated lymph node enlargement, swelling of liver and spleen, unexplained fever, and diffuse itch.[symptoma.com]
  • The nodes may also feel rubbery and swollen when examined Splenomegaly: enlargement of the spleen occurs in about 30% of people with Hodgkin's lymphoma Hepatomegaly: enlargement of the liver, due to liver involvement, is present in about 5% of cases.[slideshare.net]
Lymphocytes Increased
  • Infection : Certain viral and bacterial infections that transform lymphocytes increase the risk, such as the Epstein-Barr virus (EBV), which causes glandular fever.[medicalnewstoday.com]
Pleural Effusion
  • Pericardial and pleural effusions developed in one patient after cycles 4 and 5 of GV, consistent with gemcitabine-induced radiation recall. There were no toxic deaths.[ncbi.nlm.nih.gov]
  • effusion from lymphatic obstruction About 1/3 have pleural effusions Effusion usually does not contain malignant cells Pneumonic form Diffuse nonsegmental infiltrate (pneumonic type) Massive lobar infiltrates (30%) Homogeneous confluent infiltrates with[learningradiology.com]

Treatment

Patients with Hodgkin’s disease may benefit from these treatment modalities depending on the histologic type and stage of the disease. The main objective of the treatment regimen in Hodgkin’s disease is to eliminate as many cancer cells and bring the patient in the state of remission. The following treatment options are available for Hodgkin’s disease:

  • Chemotherapy: This involves the introduction of cytotoxic drugs through the vein or orally to reach the cancer cells through the blood stream. Chemotherapy is used in combination with radiotherapy in the early stage of Hodgkin’s disease. A new drug developed for Hodgkin’s disease relapse cases called Brentuximab vedotin has shown promising results among patients [9]. Chemotherapy can complicate to leukemia, fertility problem, heart damage and lung damage.
  • Radiotherapy: Radiation therapy is used in combination to chemotherapy but are used singly to treat early stages of the Lymphocyte predominant type of Hodgkin’s disease. Radiotherapy shares the same complications with chemotherapy. Malignant mesothelioma may complicate with radiotherapy [10].
  • Stem cell transplant: This type of treatment involves the replacement of bone marrow with healthy stem cells derivatives. This option is used for patients who undergo frequent relapse. Stem cell replacement therapy usually follows radiotherapy and chemotherapy to restore the healthy bone marrow cells of the bones. 

Prognosis

The cure rate for Hodgkin’s disease rises up to 80% in patients treated early with chemotherapy with or without radiation therapy. Patients who experience relapse in a period of 12 months from full remission carry a poor prognosis.

Attributes like age of more than 45 years old, male sex, and involvement of many extranodal sites increase the likelihood of relapse for Hodgkin’s disease. Immunocompromised hosts like patients beyond 55 years old with Epstein Barr Virus infection may have poor prognosis with Hodgkin’s disease [8].

Complications

The following diseases are commonly seen as a complication of Hodgkin’s disease:

Etiology

The exact etiology of Hodgkin’s disease is still unknown to this date. Theories have been postulated like a B-cell mutation that causes it to be abnormally big (Reed-Sternberg cells) and to proliferate indefinitely compressing other normal cells to exert its symptomatology.

Some theories suggests the participation of the Epstein Barr Virus (EBV) in the etiology because it is present in at least 30% of Hodgkin’s disease cases [2].

Treatment approach and prognostic outlook differs per subtype of Hodgkin’s lymphoma. There is a close correlation between Hodgkin’s disease and family history where siblings have up to 7 folds risk of acquiring the disease when a family member has been diagnosed to have one [3].

Epidemiology

The current average incidence rate of Hodgkin’s disease in the United States for both sexes is 2.9 cases per 100,000 population [4]. According to the National Cancer Institute (NCI), at least 9,000 new cases of Hodgkin’s disease have been reported in Europe along with more than 1,100 deaths recorded for the year 2014 so far [5].

Hodgkin’s disease has a predilection among male children in up to 85% of cases in the United States. This disease has been found to have low incidence rate among Asians and Pacific Islanders.

Hodgkin’s lymphoma has bimodal peak observed initially in young adults (15-34 years old) with the nodular sclerosing type, and peaks again beyond 55 years old presenting with the mixed cellularity type of Hodgkin’s disease [6].

Sex distribution
Age distribution

Pathophysiology

The pathophysiology of Hodgkin’s disease is believed to have originated in the clonal transformation of the B-cell which gives rise to the large bi-nucleate B-cells known as Reed-Sternberg cells. Other than the genetic susceptibility inherent to the individual the following environmental risk factors have noted to cause Hodgkin’s disease in an otherwise healthy host:

Prevention

Because the exact mechanisms that cause Hodgkin’s disease are still unknown, no modifiable lifestyle practices can prevent the emergence of Hodgkin’s disease.

Summary

Hodgkin’s disease or Hodgkin’s lymphoma is a clinical disorder characterized by localized or disseminated of proliferation of the lymphoreticular system of the body. These carcinogenic degeneration involves the spleen, lymph nodes, liver and the bone marrow.

The abnormal proliferation of lymphatic cells may compromise the immune system of the patient. The advances in medical science have allowed us to discover Hodgkin’s disease early in its clinical course and which has dramatically improved the prognosis in patients with this disease.

The World Health Organization (WHO) have classified Hodgkin’s lymphoma into five distinct types according to histology: The lymphocyte rich, lymphocyte depleted, mixed cellularity, nodular sclerosing and the nodular lymphocyte predominant types [1].

Patient Information

Definition

Hodgkin’s disease or Hodgkin’s lymphoma is a localized or disseminated cancer of the lymphoreticular system of the body. 

Cause

Hodgkin’s disease is caused by a clonal mutation of the B-cells that gives rise to the large bi-nucleated Reed-Sternberg’s cells causing compression signs in the bone marrow, spleen, lymph nodes and liver. This inherently lowers the immune response of the patients.

Symptoms

Painless local or disseminated lymph node enlargement, swelling of liver and spleen, unexplained fever, and diffuse itch.

Diagnosis

Lymph node and bone marrow biopsy confirms the diagnosis of Hodgkin’s disease where the patient is submitted for immediate treatment.

Treatment and follow up

Diagnosed patients are treated in combination of radiotherapy and chemotherapy. After both therapies, a stem cell replacement is performed to replace bone marrow cells with a new and healthy stem cell. Patients should be vigilant of a possible relapse within 12 months from the start of treatment.

References

Article

  1. Jaffe ES, Harris NL, Stein H, Vardiman JW, eds. World Health Organization Classification of Tumours: Pathology and Genetics of Tumours of Haematopoietic and Lymphoid Tissues. Lyon, France: IARC Press; 2001.
  2. Staal SP, Ambinder R, Beschorner WE, Hayward GS, Mann R. A survey of Epstein-Barr virus DNA in lymphoid tissue. Frequent detection in Hodgkin's disease. Am J Clin Pathol. Jan 1989; 91(1):1-5.
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Last updated: 2019-07-11 21:46