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Hodgkin Lymphoma : Clinical Features

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There is some correlation between the histologic subtype and clinical presentation in classic Hodgkin lymphoma (cHL).

Nodular Sclerosis: Most patients are young adults; M=F; usually presents in stage I or II, typically involving one or more lymph node regions above the diaphragm. Cervical, supraclavicular, and/or mediastinal lymph nodes and adjacent structures are often involved. Spleen and bone marrow involvement is seen in 10% and 3% of cases respectively.

Mixed cellularity: more frequently seen in patients with HIV infection and in resource-poor areas; associated with older age and tends to present at more advanced stages, usually stage III or IV and with B symptoms. Lymph node regions below or on both sides of diaphragm are usually involved. Splenic and bone marrow involvement is seen in 30% and 10% of cases respectively. Mediastinal lymph nodes are usually spared.

Lymphocyte-rich cHL: associated with older age; presents with stage I or II disease (70% of cases). There is usually no bulky mediastinal disease or B symptoms.

Lymphocyte-depleted cHL is more frequent in older men, HIV-infected individuals, and in low income countries; presents with fever and advanced disease (stage III or IV) with involvement of abdominal organs and bone marrow, resulting in pancytopenia or lymphopenia, hepatomegaly, and no peripheral lymphadenopathy.

About this image: The image shows cHL, nodular sclerosis, causing massive enlargement of mediastinal lymph nodes. The specimen measured 12 cm. in greatest dimension. Note the anthracotic pigment in some nodes. The cut surface shows multiple nodules surrounded by bands of fibrosis.

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