Clinical Features of Hodgkin’s Lymphoma

Summary

Hodgkin’s Lymphoma is painless lymphadenopathy. There may be systemic symptoms (B symptoms) such as night sweats and weight loss. Other symptoms may include Pel-Ebstein fever, alcohol-induced pain, and pruritus.

Introduction of Hodgkin’s Lymphoma

Classic Hodgkin’s lymphoma is any lymphoma type that contains a type of cell called Reed-Sternberg cells. Reed-Sternberg cells are abnormal B lymphocytes (white blood cells that make antibodies to fight infection). Typically, Hodgkin lymphoma is painless lymphadenopathy. There may be systemic symptoms (B symptoms) such as night sweats and weight loss.

A less common sign of Hodgkin’s disease is a pain in the affected organ after drinking alcohol.

Most patients with Hodgkin’s lymphoma suffer from the localized disease (stages I and II), and patients with extranodal involvement are often staged as the advanced stage ​1​. Classical Hodgkin lymphoma consists of four different sub-types nodular sclerosing HL (NSHL), which is the most common histological subtype, lymphocyte-rich HL (LRHL), mixed cellularity HL (MCHL) and lymphocyte depletion HL (LDHL) ​2​. The epidemiological patterns are explained for Hodgkin lymphoma concerned with age at presentation, the developmental level of a country, and its association with the Epstein–Barr virus (EBV). Hence, all these factors contribute to determining Hodgkin lymphoma’s clinical aspects.

A high erythrocyte sedimentation rate (ESR), age, the number of lymph nodes involved, and the presence of extranodal disease are the significant prognostic factors that evolved in determining the clinical features of Hodgkin’s lymphoma.

Some of the common clinical features of Hodgkin’s Lymphoma are as follows:

Painless lymphadenopathy ​1,3​

  • Cervical lymph nodes (~60-70% of patients) > axillary lymph nodes (~25-35% of patients) > inguinal lymph nodes (~8-15% of patients).
  • involvement of a group of lymph nodes.
  • Adjacent lymph node spread.
  • Mediastinum- dry cough, chest pain, and shortness of breath.
  • Hepatomegaly or splenomegaly may occur if the liver or spleen is involved, respectively.

B symptoms of Hodgkin’s Lymphoma​1​

  • Night sweats, weight loss >10% in the past six months, fever >38°C (100.4°F).
  • It may occur in a variety of diseases.
  • If HL is confirmed, B symptoms are sufficient for a positive diagnosis.

Pel-Ebstein fever

Intermittent fever is followed by 1-2 weeks of high fever followed by 1-2 weeks without fever—relatively rare but very specific HL.

Alcohol-induced pain

Pain after alcohol consumption is associated with lymph nodes. Relatively rare, but very specific HL.

Pruritus of Hodgkin’s Lymphoma (generalized or focal)

For more information regarding the signs and symptoms of Hodgkin’s Lymphoma refer to Symptoms and Signs of Hodgkin’s Lymphoma

References

  1. Mauch P, Kalish L, Kadin M, Coleman C, Osteen R, Hellman S. Patterns of presentation of Hodgkin disease. Implications for etiology and pathogenesis. Cancer. 1993;71(6):2062-2071. doi:10.1002/1097-0142(19930315)71:6<2062::aid-cncr2820710622>3.0.co;2-0
  2. Li ZM, Zhu YJ, Xia Y, Huang JJ, Jiang WQ. Clinical characteristics of the patients with Hodgkin’s lymphoma involving extranodal sites. Chin J Cancer. Published online July 5, 2012:342-347. doi:10.5732/cjc.012.10008
  3. Mauch PM, Kalish LA, Kadin M, Coleman CN, Osteen R, Hellman S. Patterns of presentation of Hodgkin disease. Implications for etiology and pathogenesis. Cancer. Published online March 15, 1993:2062-2071. doi:10.1002/1097-0142(19930315)71:6<2062::aid-cncr2820710622>3.0.co;2-0