Hodgkin's Disease

As noted previously, Hodgkin's disease is a group of disorders with a characteristic clinical course. The early studies by Henry Kaplan defined the typical pattern of spread of Hodgkin's disease. As opposed to the non-Hodgkin's lymphomas, Hodgkin's disease tends to spread to contiguous lymph node groups. Thus, intricate staging at the time of diagnosis is critical for developing a plan of treatment. The incidence of Hodgkin's disease demonstrates a bimodal age-specific pattern. There is an early peak between the ages of 20 and 30. Some have suggested that there is an infectious etiology for this form of Hodgkin's disease as there is increasing risk for Hodgkin's disease with higher socioeconomic status. The later peak, occurring about age 50, is not related to socioeconomic status. There are many reasons to think that the etiology of the early peak of Hodgkin's diseases is different from the etiology of the cases that occur in elderly individuals.

Classification and Clinical Presentation
All forms of Hodgkin's disease have demonstrable Reed-Sternberg cells, which are large binucleated cells with prominent nucleoli, and although not pathognomic for Hodgkin's disease these are typical. The debate regarding the origin of this cell continues. There are four subtypes of Hodgkin's disease. In decreasing frequency, they are nodular sclerosing, mixed cellularity, lymphocyte predominant, and lymphocyte depleted.

Most patients present with an enlarged lymph node; however, there is some difference in the clinical presentation from older to younger patients. Older patients are more likely to have systemic symptoms and abdominal disease, especially bulky abdominal disease. The most common histologic pattern in all age groups is nodular sclerosing, but it appears from a multitude of studies that with advancing age there is decreasing nodular sclerosis and increasing mixed cellularity.

The clinical presentation of Hodgkin's disease as noted is typically with adenopathy, with more than 70% of people presenting with palpable lymph node enlargement. Rarely, the lymph nodes become painful after consumption of alcoholic beverages. As many as a third of patients will develop so-called B symptoms with fevers, night sweats, and weight loss of more than 10% of body weight. Other symptoms such as fatigue, weakness, and pruritus occur commonly but are not officially considered B symptoms. Presence of true B symptoms has adverse prognostic implications.