Hodgkin's lymphoma

Background

• Spreads from source lymph node to adjacent nodes
• About half of cases related to Epstein-Barr virus
  • HIV is also a risk factor
• More common in males
• Bimodal distribution: young adulthood and older aged
• Most common malignancy in ages 15-19 years
• Survival >90% in low-risk patients

Clinical Features

• Painless, firm, lymph node (usually cervical or supraclavicular)
• "B" symptoms: fever, night sweats, weight loss

Differential Diagnosis

Cervical Lymphadenopathy

• Hodgkin's lymphoma
• Non-Hodgkin's lymphoma
• Mononucleosis
• Toxoplasmosis
• Branchial cleft lesions
• Cat scratch disease
• Mycobacterial adenitis

Acute Leukemia/Lymphoma

• Acute myeloid leukemia
• Acute lymphocytic leukemia
• Hodgkin's lymphoma
• Non-Hodgkin's lymphoma

Lymphadenitis

Infectious

• Reactive adenitis
• Bacterial lymphadenitis
• Tuberculous lymphadenitis
• Cellulitis
• Cat-scratch disease
• Parotitis
  • Suppurative parotitis
  • Viral parotitis
• Lymphangitis
• Toxoplasmosis
• Tularemia
• Viral disease
  • HIV-AIDS
  • Cytomegalovirus
  • Epstein-Barr Virus
• Fungal disease
• Reactive adenitis

Non-Infectious

• Malignancy
  • Lymphoma
  • Metastatic cancer
• Rheumatologic Disease
  • Kawasaki Disease
  • Systemic lupus erythematosus
  • Sarcoidosis
  • Juvenile Idiopathic Arthritis
  • Langerhans Cell Histiocytosis
• Cutaneous Lesions:
  • Bacillary angiomatosis
  • Purpura
  • Hematomas
  • Angiomas
  • Dermatofibromas
  • Nevi
• Drug reaction
  • Phenytoin or Carbamazepine
• Postvaccination
• Sarcoidosis
• Salivary gland diagnoses

Evaluation

• CXR
• CT neck/chest/abdomen/pelvis
• Lymph node biopsy
  • Reed-Sternberg cells next to normal lymphocytes

Management

• Manage acute complications
  • Superior vena cava syndrome
  • Upper airway compression
    • Do NOT give steroids (citation/rationale?)
  • Tumor lysis syndrome
  • Neutropenic fever
  • Chemo-induced nausea/vomiting

See Also

• Lymphoma
• Non-Hodgkin's lymphoma
• Oncologic emergencies