Presentation of Hodgkin Lymphoma
Clinical Presentation
The most common presentation of Hodgkin lymphoma is painless, progressive cervical or supraclavicular lymphadenopathy, typically occurring in young adults with a bimodal age distribution peaking at 15-30 years and after age 55. 1, 2
Lymphadenopathy Characteristics
- Painless lymph node enlargement is the hallmark feature, most commonly affecting cervical nodes (supradiaphragmatic distribution) 1, 3, 4
- The lymphadenopathy is typically progressive and non-tender, distinguishing it from infectious causes 2, 5
- Mediastinal involvement may present as an asymptomatic mediastinal mass discovered incidentally on chest imaging 4, 6
Constitutional B Symptoms
- B symptoms occur in a significant proportion of patients and include: 1, 2
- Fever (often cyclical, known as Pel-Ebstein fever)
- Drenching night sweats
- Unexplained weight loss exceeding 10% of body weight over 6 months
- The presence of B symptoms is a critical prognostic factor and influences staging classification 1
Additional Disease-Related Symptoms
- Pruritus (generalized itching) occurs in some patients and can be severe 1
- Alcohol-induced pain at sites of lymph node involvement is a rare but characteristic symptom 1
- Fatigue is commonly reported 1, 4
- Respiratory symptoms including chronic cough, dyspnea, and pleuritic chest pain may occur with mediastinal or pulmonary involvement 3, 4
Physical Examination Findings
- Palpable lymphadenopathy in cervical, supraclavicular, or axillary regions 1, 2
- Hepatosplenomegaly may be present in advanced disease 5
- Signs of superior vena cava syndrome in cases of large mediastinal masses 4
Laboratory Abnormalities
- Elevated erythrocyte sedimentation rate (ESR) is common and serves as a risk factor for staging 1
- Elevated lactate dehydrogenase (LDH), alkaline phosphatase, and C-reactive protein may be present 1
- Anemia, leukocytosis, or lymphopenia can occur 1, 7
Uncommon Presentations
- Extranodal involvement is rare but can affect lungs, liver, bone marrow, or bone 1, 5
- Approximately 5% of cases present as nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL), which has a different natural history and immunophenotype (CD20+/CD15-/CD30-) compared to classical Hodgkin lymphoma 1, 2