SN7 SHORT NOTE 5M

Define Hodgkin Lymphoma. Describe its classification, aetiology, clinical features and investigations.

Pediatrics · Final Professional

Hodgkin lymphoma (HL) is a malignant lymphoma arising in lymph nodes, characterised by the presence of the diagnostic Reed-Sternberg (RS) cell — a large binucleate cell with prominent eosinophilic nucleoli giving an 'owl-eye' appearance — surrounded by a reactive inflammatory background.
It shows a bimodal age distribution (adolescents/young adults and older adults).

Two broad groups — Classical HL (~95%) (RS cells are CD15+ and CD30+) and Nodular lymphocyte-predominant HL:

Subtype	Key features
Nodular sclerosis	Commonest (~70%); adolescents; mediastinal mass; lacunar cells
Mixed cellularity	2nd commonest; EBV-associated; older/immunocompromised
Lymphocyte-rich	Few RS cells; good prognosis
Lymphocyte-depleted	Many RS cells; worst prognosis; HIV-associated
Nodular lymphocyte-predominant	'Popcorn' (L&H) cells, CD20+; indolent, late relapses

Painless, firm, rubbery lymphadenopathy — most often cervical/supraclavicular; spreads in a contiguous (predictable, node-to-adjacent-node) fashion.
Mediastinal mass — cough, dyspnoea, or superior vena cava obstruction.
'B symptoms' — fever > 38 °C, drenching night sweats, and weight loss > 10% over 6 months (indicate a worse prognosis).
Classical clues — Pel-Ebstein (cyclical) fever, alcohol-induced nodal pain, and generalised pruritus.
Hepatosplenomegaly and, in advanced disease, marrow involvement.

Excisional lymph-node biopsy — the diagnostic test; demonstrates Reed-Sternberg cells with immunophenotyping (CD15/CD30).
CBC (anaemia), ESR and LDH (raised; prognostic), renal/liver function.
Contrast CT (neck, chest, abdomen, pelvis) and pet-CT for staging; chest X-ray for a mediastinal mass.
Bone-marrow biopsy for advanced-stage/B-symptom disease.

Stage	Extent
I	A single lymph-node region
II	≥ 2 regions on the same side of the diaphragm
III	Regions on both sides of the diaphragm (± spleen)
IV	Diffuse extranodal spread (liver, marrow, lung)

Suffixes: A (no B symptoms), B (B symptoms present), E (extranodal extension), S (splenic), X (bulky disease).

Feature	Hodgkin lymphoma	Non-Hodgkin lymphoma
Cell	Reed-Sternberg cell	No RS cell
Spread	Contiguous (orderly)	Non-contiguous ('skip' lesions)
Extranodal disease	Uncommon	Common
Site	Usually cervical/mediastinal	Often abdominal / widespread
Presentation	Nodal, B symptoms	May be an emergency (mass, tumour lysis)
Prognosis	Excellent	Variable

Risk-adapted chemotherapy — the standard regimen is ABVD (Adriamycin/doxorubicin, Bleomycin, Vinblastine, Dacarbazine), with the number of cycles guided by stage and pet response.
Involved-field/site radiotherapy is added for bulky or residual disease (used cautiously in children to limit late effects).
Treatment intensity is tailored (de-escalated for pet-negative early disease).

Excellent prognosis — cure rates > 90% in early-stage childhood HL.
Late effects of therapy — second malignancies, anthracycline cardiotoxicity, bleomycin lung toxicity, hypothyroidism (neck radiation) and infertility — hence long-term survivorship follow-up.

Painless rubbery cervical nodes with B symptoms.

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