Hodgkin’s Lymphoma

Overview – Hodgkin’s Lymphoma

Hodgkin’s Lymphoma is a type of malignant lymphoma involving abnormal B-lymphocytes and characterised by the presence of Reed-Sternberg cells. It accounts for around 15% of all lymphomas and typically presents in young adults. Although its aetiology remains unclear, Epstein-Barr Virus (EBV) is a known risk factor. With appropriate therapy, Hodgkin’s Lymphoma carries a high cure rate and favourable prognosis.

Definition

• A malignant neoplasm of B-cell lineage, affecting lymph nodes and sometimes peripheral organs
• Hallmark: Reed-Sternberg cells (large, abnormal multinucleated B-cells)

Aetiology

• Idiopathic
• EBV infection – linked to 40–50% of cases
• Risk factors:
  • Family history
  • Male gender
  • Immunosuppression

Pathophysiology

• Malignant transformation of B-lymphocytes
• Proliferation of tumour cells within lymph nodes → painless lymphadenopathy
• Systemic spread to spleen, liver, bone marrow
• Reed-Sternberg cells secrete cytokines → systemic symptoms (“B symptoms”)

Clinical Features

Age Distribution

• Bimodal:
  • Peak 1: Young adults (15–35 years)
  • Peak 2: Older adults (55+ years)

Symptoms

• Painless, asymmetrical lymphadenopathy
  • Commonly cervical or axillary
• B symptoms:
  • Fever
  • Night sweats
  • Weight loss
• Pruritus
• Alcohol-induced lymph node pain (pathognomonic)
• Hepatosplenomegaly

Investigations

• Lymph node biopsy:
  • Confirms diagnosis
  • Presence of Reed-Sternberg cells (binucleated or multinucleated giant cells)
• Bone marrow biopsy (for staging)
• CT scan (chest, abdomen, pelvis):
  • Evaluates extent of disease and mediastinal mass
• Blood tests:
  • FBC, LDH, ESR (for inflammation and disease activity)

Management

• Depends on Ann Arbor staging
• Curative intent in most cases
• Early-stage disease:
  • Radiotherapy +/- chemotherapy
• Advanced disease:
  • Combination chemotherapy (e.g., ABVD regimen)
• Refractory/relapsed disease:
  • Autologous stem cell transplant

Complications

• SVC obstruction:
  • Due to mediastinal masses
  • Presents with ↑JVP, facial swelling, and dyspnoea
• Long-term treatment complications:
  • Secondary malignancies
  • Infertility
  • Cardiotoxicity (from anthracyclines)

Summary – Hodgkin’s Lymphoma

Hodgkin’s Lymphoma is a highly curable malignancy of B-lymphocytes, frequently presenting with painless lymphadenopathy and B symptoms in young adults. Diagnosis is confirmed by lymph node biopsy showing Reed-Sternberg cells. Treatment varies by stage and typically involves chemotherapy and/or radiotherapy. For more, see our Blood & Haematology Overview page.