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Hodgkin Lymphoma : Clinical Features

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Clinical Features: About 90% of cases of classic Hodgkin lymphoma (cHL) present with progressive, painless lymphadenopathy involving one or two superficial supradiaphragmatic lymph node regions such as cervical (75%), axillary or mediastinal. Patients with nodular sclerosis cHL frequently have bulky, asymptomatic involvement of mediastinal lymph nodes that is detected incidentally on imaging studies done for another reason. Retroperitoneal lymph nodes and spleen are frequently involved. Extra-axial lymph node groups are rarely affected. Bone marrow involvement occurs in only about 5% of cases.

B symptoms are seen in 30% to 40% of cHL patients, usually in advanced stages. They include weight loss (unexplained weight loss of >10% of body weight in 6 months prior to diagnosis), drenching night sweats (often requiring change of bedclothes), and fevers (unexplained fever with temperatures above 38 C; cyclic Pel-Ebstein fever). Symptoms such as fatigue, generalized pruritus, and alcohol-induced pain are not included in A or B designation but should be recorded.

Massive mediastinal lymph node enlargement can produce cough, dyspnea, and chest pain due to compression of nearby structures. There may be pain due to bone erosion or compression of nerves.

Laboratory findings are usually non-specific and include: leukocytosis, elevated erythrocyte sedimentation rate, increased LDH, eosinophilia (20% of cases), lymphopenia (advanced stages), decreased CD4+ cells in peripheral blood, defects in cell-mediated immunity causing increased susceptibility to infection and lack of reactivity in tuberculin skin test.

About this image: This photograph shows massively enlarged cervical lymph nodes in a teen. The final diagnosis was classic Hodgkin lymphoma, nodular sclerosis type. (clinical features continued in the next image)

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