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Hodgkin Lymphoma

 

 

Investigation

 

The first investigation is always a complete history and physical.

Laboratory studies show non-specific abnormalities.

 

Work-up for Hodgkin Lymphoma:

History

Clinical history:

  • Presence of B symptoms
  • Presence of other constitutional symptoms
  • General performance status
  • Signs of CNS involvement

 

Past medical history:

  • Evidence of prior infection (specifically mononucleosis)
  • Underlying immune deficiencies and familial cancers

 

Examination

Assess and document size and location of lymphadenopathy, liver and spleen:

  • Identify the presence and size of all abnormal lymph nodes
  • Essential to evaluate Waldeyer’s ring

 

Routine cardiopulmonary examination

  • identify mediastinal involvement and pulmonary findings

 

CNS evaluation for all neurologic signs

 

Evaluate oral cavity for condition of teeth, tongue and nsaopharynx

 

Lab Studies

CBC - number of abnormalities seen:

  • Normochromic normocytic anemia common.
  • neutrophilic leukocytosis (50% patients)
  • eosinophilia (15% patients)
  • lymphopenia (advanced disease)

 

Erythrocyte sedimentation rate

  • Elevated due to activation of reticuloendothelial system

 

Serum copper and ferritin elevated

 

Hepatic function tests

  • may be elevated

 

Renal Function tests

 

C-reactive protein elevated

 

Serum alkaline phosphatase

  • Elevated level may indicate bone or liver involvement

 

Lactate dehydrogenase

 

Imaging Studies

Initial chest X-ray

 

CT scan of chest, abdominal and pelvis

 

PET scan - If available CT-PET is scan of choice

Pathology

Lymph node biopsy

 
BM exam

Bone marrow involvement is very rare - but can occur in advanced disease

 

Bone marrow biopsy and aspiration for:

  • B-symptoms
  • Stage III or IV
  • Anemia, Leukopenia or Thrombocytopenia


Lymph Node Biopsy

Hodgkin lymphoma diagnosis is made by pathological examination of an involved lymph node

  • Excisional lymph node biopsy
  • CT guided needle biopsy

For lymph node biopsies:

  • Largest and most clinically suspicious node should be removed 
  • Biopsy material should be assessed for additional histological information from flow cytometry and immunophenotyping
  • Excisional biopsy is preferred to needle biopsy to allow for assessment of nodal architecture and increase potential yield of diagnostic HRS cells

 

 

 

 

 

 

 

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