Classical Hodgkin’s Lymphoma

Presentation

  • Non tender lymphadenopathy most commonly in the upper body
  • Subdiaphragmatic lymphadenopathy is uncommon
  • 1/3 have B symptoms
  • Pel-Ebstein fever describes days to weeks of persistent fevers seperated by an afebrile period
  • Cutaneous manifestations include
    • Erythema nodosum
    • Ichthyosiform atrophy
  • Other presentations
    • Cerebellar degeneration
    • Nephrotic syndrome
    • Immune haemolytic anaemia
    • Thrombocytopaenia
    • Hypercalcemia
    • Lymph node pain on alcohol ingestion

Pathology

  • Reed-Sternbeg cell is the hallmark
  • Rare neoplastic B cells in a polyclonal inflammatory mass

Workup

  • CT chest/abdo/pelvis
  • PET or gallium scan
  • LDH
  • The usual baseline bloods

Treatment

  • Cure rate >90% for localised disease
  • Localised disase – neoadjuvant chemo + radiotherapy
  • Extensive disease – chemotherapy
  • Late side effects important due to very high cure rate
    • Carcinomas
    • Acute leukaemias
    • ¬†Coronary artery disease
    • Hypothyroidism
    • Lhermitte’s sundrome
    • Infertility
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