Haema 2012; 3(3): 203-211
by Gerasimos A. Pangalis1,2, Maria Moschogiannis1, Xanthi Giakoumi1, Pantelis τsirkinidis1,3, Sotirios Sachanas1
1Department of Haematology, Athens Medical Center, Psychikon Branch,
2Department of Haematology, National and Kapodistrian University of Athens,
3Department of Haematology, 401 General Army Hospital, Athens, Greece
Abstract
Hodgkin lymphoma usually affects young adults. The majority of patients present with asymptomatic, non-tender, hard and fixed lymphadenopathy of the cervical, supraclavicular and/or axillary areas. The disease commonly involves the upper mediastinum in the form of bulky lymphadenopathy. 30-40% of the patients, mostly with advanced stage disease, develop B-symptoms, which include fever (usually >38˚C) which frequently has a cyclical high-grade character, drenching nights sweats and weight loss (≥10% of the body weight in 6 months). Pain in the affected areas after consumption of alcoholic drinks is a rare but specific disease characteristic. Cervical and supraclavicular lymph nodes are most commonly affected, followed by mediastinal, paraortic and axillary lymph nodes, while spleen involvement is reported in 20% of patients. The disease is rarely pure infradiaphragmatic while lung, bone marrow and liver involvement are the commonest extranodal sites of disease. Laboratory findings are usually normal, especially at early disease stage, whereas advanced disease is commonly accompanied by anemia, leukocytosis with neutrophilia, lymphocytopenia and thrombocytosis. More than 50% of patients present with elevated ESR, while increased LDH, β2-microglobulin, a2 globulins and acute phase proteins are observed in various percentages of patients. Staging procedures include plain chest X-rays and whole body computed tomographies. FDG PET CT scan contributes to the evaluation of disease sites undetectable by conventional imaging techniques as well as residual masses. Bone marrow trephine biopsy is necessary. The disease stage constitutes an important prognostic factor.