Chapter 19: Hodgkin Lymphoma

Hodgkin Lymphoma malignant cells typically exist within a vast environment of reactive inflammatory cells, distinguishing the condition from other types of lymphoma. The discussion details the pathogenesis, noting that these cells often carry mutations that prevent the synthesis of full-length immunoglobulins and frequently show a strong association with the Epstein-Barr virus. Clinical presentation often involves painless, firm swelling of the lymph nodes, particularly in the cervical region, and may be accompanied by systemic indicators known as B symptoms, which include drenching night sweats, significant weight loss, and persistent fevers. The text emphasizes the importance of accurate histological classification, dividing the disease into classical types—such as nodular sclerosis, mixed cellularity, and lymphocyte-depleted—and the unique nodular lymphocyte-predominant variety which features "popcorn" cells. Diagnostic staging is performed using the Ann Arbor system, which categorizes the extent of disease based on its spread relative to the diaphragm and the presence of extranodal involvement. Modern management relies heavily on functional imaging, specifically PET/CT scans, which utilize the Deauville scoring system to evaluate metabolic response to therapy. Treatment strategies have evolved to balance high cure rates with the minimization of long-term toxicity, utilizing chemotherapy combinations like ABVD or intensive BEACOPP, sometimes alongside localized radiotherapy. Advanced cases or relapses may be managed with targeted biological agents such as anti-CD30 monoclonal antibodies, immune checkpoint inhibitors that block the PD-1 pathway to re-engage the immune system, or autologous stem cell transplantation. While the prognosis for most patients is excellent, with a high percentage achieving a permanent cure, the chapter underscores the necessity of monitoring for late-onset complications, including secondary cancers and cardiovascular or pulmonary damage resulting from previous treatments.