Hodgkin lymphoma or Hodgkin disease (HD) is a type of lymphoma and accounts for ~1% of all cancers. HD spreads contiguously and predictably along lymphatic pathways and is curable in ~90% of cases, depending on its stage and sub-type.
There is a bimodal distribution in the age of affected patients, with peaks in young adults (15-34 years) and older patients (>55 years).
Typical presention is with painless lymphadenopathy. Systemic symptoms (B symptoms) such as night sweats and weight loss may be present.
An uncommon presentation described in Hodgkin disease is pain in involved organs following alcohol consumption.
The disease is characterised by the presence of Reed-Sternberg cells (considered to be a type of B cell). These cells however only occupy a very small proportion (<5%) of the overall cell population of the affected lymph node. Contiguous spread is another feature. EBV infection is present in 40-80% depending on subtype 4.
There are five recognised histological sub types.
Positive for CD15/CD30 and negative for CD20/CD45/EMA:
- nodular sclerosing: ≈70%
- mixed cellularity: ≈25%
- lymphocyte rich: 5%
- lymphocyte depleted: <5%
Positive for CD 19, 20, 22, 79a/EMA and negative for CD15/CD30:
- nodular lymphocyte predominant (nodular paragranuloma)
For classification of lymphomas see WHO classsification of neoplasms of lymphoid tissues.
Hodgkin's disease is usually almost entirely confined to the lymph nodes.
Extranodal HD although uncommon may be found in any organ system, either as a primary manifestation or as dissemination of systemic disease. This distinction is important, as disseminated disease carries a poorer prognosis. Extranodal disease may occur via invasion of adjacent tissue or via haematogenous spread.
Organ specific involvement:
- pulmonary manifestations of Hodgkin lymphoma
- cardiac manifestations of Hodgkin lymphoma
- musculoskeletal manifestations of Hodgkin lymphoma
- abdominal manifestations of Hodgkin lymphoma
- CNS manifestations of Hodgkin lymphoma
In contrast to other types of lymphoma, Hodgkin disease is usually characterised by a systematic nodal spread pattern making accurate staging important.
See main article: Hodgkin lymphoma staging.
Treatment and prognosis
Prognosis depends on stage as well as several other factors such as age, serological markers (ESR), presence of B symptoms, and histological tumour subtype:
- nodular lymphocyte predominant: best prognosis
- lymphocyte depleted: worse prognosis
Treatment is dependant on the stage of disease:
- stage IIa and below: localised radiotherapy
- stage IIb and above: chemotherapy +/- radiotherapy to sites of large tumour bulk
- overview of lymphoma
WHO classification of tumours of haematopoietic and lymphoid tissues
- Hodgkin lymphoma
mature B-cell lymphoma
- Burkitt lymphoma
- follicular lymphoma
- lymphoplasmacytic lymphoma (Waldenström's macroglobulinaemia)
- lymphomatoid granulomatosis
- mantle cell lymphoma
- mature T-cell and NK-cell lymphoma
- post-transplant lymphoproliferative/lymphoproliferation disorders
- mature B-cell lymphoma
- location-specific lymphomas
- central nervous system
- head and neck lymphoma
- thoracic lymphoma
- gastrointestinal lymphoma
- hepatobiliary lymphoma
- genitourinary lymphoma
- musculoskeletal lymphoma
- cutaneous lymphoma
- lymphoma staging
- 1. Guermazi A, Brice P, de Kerviler E E et-al. Extranodal Hodgkin disease: spectrum of disease. Radiographics. 21 (1): 161-79. Radiographics (full text) - Pubmed citation
- 2. Toma P, Granata C, Rossi A et-al. Multimodality imaging of Hodgkin disease and non-Hodgkin lymphomas in children. Radiographics. 27 (5): 1335-54. doi:10.1148/rg.275065157 - Pubmed citation
- 3. Hopper KD, Diehl LF, Lesar M et-al. Hodgkin disease: clinical utility of CT in initial staging and treatment. Radiology. 1988;169 (1): 17-22. Radiology (abstract) - Pubmed citation
- 4. Delecluse HJ, Feederle R, O'Sullivan B et-al. Epstein Barr virus-associated tumours: an update for the attention of the working pathologist. J. Clin. Pathol. 2006;60 (12): 1358-64. doi:10.1136/jcp.2006.044586 - Free text at pubmed - Pubmed citation