Clinical features

The majority of patients present with painless lymphadenopathy (most commonly cervical or supraclavicular).

• mediastinal masses (present in around 80% of patients) is more common in nodular sclerosing HL and are sometimes discovered after routine chest radiography,
• peripheral or sub-diaphragmatic lymphadenopathy is more common in mixed-cellularity classical HL (1,2)

Other systemic symptoms:

• B symptoms:
• seen in approximately 25% of patients and includes
  • unexplained fever >38°C
  • drenching night sweats
  • weight loss of >10% over 6 months (1)
• generalised pruritus
• chest discomfort with a cough or dyspnoea (2)
• anaemia
• immune dysfunction

In advanced disease there may be infiltration of any organ often presenting with hepatosplenomegaly. Other sites for tumour localisation include bone, bone marrow, lung, kidneys.

• bone marrow involvement is detected in only 5-8% of patients with conventional staging but in up to 18% with PET/CT staging

The Ann Arbor system is used to stage Hodgkin's disease.

Reference:

• (1) Guidelines for the First Line Management of Classical Hodgkin Lymphoma (2014). British Committee for Standards in Haematology (BCSH)
• (2) Yung L, Linch D. Hodgkin's lymphoma. Lancet. 2003;361(9361):943-51