Hodgkin lymphoma
Hodgkin lymphoma is a B-cell malignancy defined by Reed-Sternberg cells that classically presents with painless, contiguously spreading cervical or mediastinal lymphadenopathy in a young adult, and it is confirmed by excisional lymph node biopsy. Ann Arbor/Lugano stage and interim PET response drive risk-adapted ABVD chemotherapy with or without radiation, and most patients are cured.
- Topic reviewThe full article, organized the way the exam asks it.
- ABIM-format MCQsVignettes with an explanation for every wrong answer.
- Key factsThe numbers and thresholds worth memorizing, up front.
- AI tutorMedBrain answers the question you're stuck on.
What this article covers
- Overview
Definition: a B-cell malignancy defined by Reed-Sternberg cells, large binucleate or multinucleated cells with prominent nucleoli, scattered within a reactive infiltrate of lymphocytes, eosinophils, and histiocytes.
- Epidemiology
Bimodal age distribution: an early peak at a median age of about 25 years and a second peak after age 60, unlike non-Hodgkin lymphoma, whose incidence rises steadily with age.
- Risk factors
Epstein-Barr virus infection: prior EBV infection, including infectious mononucleosis, is associated with increased risk, and EBV genome is detected within Reed-Sternberg cells in a subset of cases.
- Pathophysiology
Malignant Reed-Sternberg cells derive from germinal center B cells: they typically lose normal B-cell surface immunoglobulin and antigen receptor signaling but survive through aberrant pro-survival signaling.
- Clinical features
Painless lymphadenopathy: firm, rubbery, nontender, fixed nodes, most commonly cervical, supraclavicular, or axillary.
- Differential diagnosis
Infectious mononucleosis: fever, sore throat, and lymphadenopathy, distinguished by a positive heterophile antibody test and self-limited course (infectious mononucleosis).
- Diagnosis
Excisional lymph node biopsy showing Reed-Sternberg cells is confirmatory: diagnosis rests on Reed-Sternberg cells (large, binucleated or multinucleated cells with prominent eosinophilic nucleoli…
- Management
Establish stage and risk before starting therapy: determine Ann Arbor/Lugano stage, A/B status, and unfavorable prognostic factors, which set chemotherapy duration and whether radiation is added.
- Complications
Bleomycin pulmonary toxicity: cumulative, dose-related pulmonary fibrosis in up to 25% of patients on bleomycin-containing regimens, during treatment or within six months of completion; monitor…
- Prognosis
Overall cure rate exceeds 85% with appropriate risk-adapted therapy.
- Prevention
No primary prevention exists because its causes (EBV exposure, immune dysregulation) are not reliably modifiable.
Read the whole article
Subscribing to Internal Medicine opens every article, the full question bank and MedBrain, on the web, iPhone and Android.
Related articles
- Non-Hodgkin lymphoma
Non-Hodgkin lymphoma is a heterogeneous group of B-cell (about 85%) and T-cell lymphoid malignancies that spread noncontiguously and often involve extranodal sites, ranging from indolent follicular lymphoma to aggressive diffuse large B-cell lymphoma to highly aggressive Burkitt lymphoma. Diagnosis requires excisional or core biopsy with flow cytometry and cytogenetics, Ann Arbor staging with PET-CT, and treatment is subtype-specific, from observation to R-CHOP to intensive Burkitt regimens with aggressive tumor lysis and CNS prophylaxis.
- Infectious mononucleosis
Infectious mononucleosis is a systemic illness caused mainly by Epstein-Barr virus, presenting with fever, pharyngitis, and lymphadenopathy, confirmed by heterophile antibody or EBV-specific serology, and managed supportively with contact-sport restriction to prevent splenic rupture.
- Tuberculosis
Tuberculosis, caused by Mycobacterium tuberculosis, remains a leading global cause of infectious death and presents as latent infection, primary/secondary pulmonary disease, or extrapulmonary and disseminated (miliary) disease. Diagnosis rests on AFB smear, NAAT, and mycobacterial culture (the gold standard), and drug-susceptible active disease is treated with a four-drug regimen (isoniazid, rifampin, pyrazinamide, ethambutol) for 2 months followed by isoniazid plus rifampin for 4 to 7 months.
- Sarcoidosis
Sarcoidosis is a multisystem granulomatous disease of unknown cause defined by noncaseating granulomas, most commonly involving the lungs and hilar lymph nodes. Most patients are asymptomatic or have a self-limited course staged by chest radiograph; symptomatic organ-threatening disease is treated with systemic glucocorticoids, with methotrexate or another steroid-sparing agent added for glucocorticoid-refractory or glucocorticoid-intolerant disease.
- Toxoplasmosis
Toxoplasmosis is infection with the protozoan Toxoplasma gondii, acquired from undercooked meat or cat feces, causing a mononucleosis-like illness in immunocompetent hosts, reactivation encephalitis with ring-enhancing brain lesions in advanced HIV, and a severe congenital syndrome after maternal primary infection in pregnancy. Diagnosis in CNS disease is largely presumptive on serology, imaging, and empiric treatment response, and management is pyrimethamine-sulfadiazine-leucovorin, with prevention centered on CD4-based prophylaxis and food/cat-litter precautions in pregnancy.