Hodgkin lymphoma

Epidemiology

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Etiology

• Strong association with Epstein-Barr virus (EBV)
• Immunodeficiency: e.g., organ or cell transplantation, immunosuppressants, HIV infection , chemotherapy
• Autoimmune diseases (e.g., rheumatoid arthritis, sarcoidosis)

Hodgkin lymphoma vs non-Hodgkin lymphoma

Feature	Hodgkin Lymphoma (HL)	Non-Hodgkin Lymphoma (NHL)
Key Cell	Reed-Sternberg (“owl-eye”)	Malignant lymphocytes (B or T cell)
Spread	Contiguous (orderly, predictable)	Non-contiguous (disseminated)
Presentation	Localized, single node group (e.g., cervical, mediastinal)	Multiple peripheral nodes, extranodal common
”B” Symptoms	Common (fever, night sweats, wt loss)	Less common
Age	Bimodal (20s, >50s)	Typically >50 years old
Prognosis	High cure rate	Variable; depends on subtype
Key Associations	EBV	EBV, HTLV-1, HHV-8; translocations (e.g., t(14;18), t(8;14))

Link to original

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Pathophysiology

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Clinical features

• B symptoms
  • Night sweats, weight loss > 10% in the past 6 months, fever > 38°C (100.4°F)
• Pel-Ebstein fever: Intermittent fever with periods of high temperature for 1–2 weeks, followed by afebrile periods for 1–2 weeks. Relatively rare but very specific for HL.
• Alcohol-induced pain: Pain in involved lymph nodes after ingestion of alcohol. Relatively rare but highly specific for HL.

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Diagnostics

Histology

• Lymph node excision
  • Reed-Sternberg cells (RSCs)
    • Tumor cells that are pathognomonic of HL
    • Originate from B cells
    • Large cells with binuclear/bilobed nuclei with dark centers of chromatin and pale halos, which results in an owl-eye appearance on histopathologic examination.
    • CD15/CD30-positive
  • Hodgkin cells: mononuclear, malignant B lymphocytes
    • Polynuclear RSCs are giant cells formed through the fusion of multiple Hodgkin cells.

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Treatment

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