Snapshot A 15-year-old boy presents with fatigue and masses around his neck. The masses are small, mobile, and do not hurt. A few months ago, he had had an episode of infectious mononucleosis. He is referred for a lymph node biopsy, which comes back with positive Reed-Sternberg cells. Introduction B-cell malignancy originating in lymphatic system Pathogenesis 50% of cases associated with EBV infection Reed-Sternberg cells CD15+ and CD30+ Epidemiology bimodal distribution young adulthood > 55 years male > female Types of Hodgkin lymphoma nodular sclerosing most common mixed cellularity lymphocyte-rich & predominant especially in < 35-year-olds but also in older adults lymphocyte-depleted especially in > 60-year-olds other systemic diseases Risk factors infectious mononucleosis with EBV Presentation Symptoms constitutional ("B") symptoms fever night sweats weight loss all caused by cytokines released from Reed-Sternberg cells persistent painless lymphadenopathy Physical exam nontender mass of localized, single group of nodes rubbery mobile cervical supraclavicular axillary Evaluation Imaging for staging Lymph node biopsy Reed-Sternberg cells binucleate or bilobed, “owl-eyed” nuclei mixed cellularity type large inflammatory infiltrate with many eosinophils nodular sclerosing type diffuse band-like fibrosis with lacunar spaces Differential Diagnosis Non-Hodgkin lymphoma AIDS-related lymphadenopathy Infection Breast cancer Cat-scratch fever Treatment Based on staging Chemotherapy Radiation Prognosis, Prevention, and Complications Prognosis > 80% with treatment better than non-Hodgkin lymphoma lymphocyte-predominant = best prognosis lymphocyte-deplete = worst prognosis higher lymphocyte:RS cell ratio = better prognosis Complications SVC syndrome paraneoplastic syndromes calctriol secretion causes hypercalcemia from treatment risk of solid tumors (breast, thyroid, and lung) risk of premature coronary artery disease risk of infection