Hodgkin Lymphoma Clinical Presentation

Updated: Sep 22, 2023
  • Author: Bradley W Lash, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Features of Hodgkin lymphoma include the following:

  • Asymptomatic lymphadenopathy may be present (above the diaphragm in 80% of patients)

  • Constitutional symptoms (unexplained weight loss [>10% of total body weight] within the past 6 months, unexplained fever >38º C, or drenching night sweats) are present in 40% of patients; collectively, these are known as "B symptoms"

  • Intermittent fever is observed in approximately 35% of cases; infrequently, the classic Pel-Ebstein fever is observed (high fever for 1-2 wk, followed by an afebrile period of 1-2 wk)

  • Chest pain, cough, shortness of breath, or a combination of those may be present due to a large mediastinal mass or lung involvement; rarely, hemoptysis occurs

  • Pruritus may be present

  • Pain at sites of nodal disease, precipitated by drinking alcohol, occurs in fewer than 10% of patients but is specific for Hodgkin lymphoma

  • Back or bone pain may rarely occur

  • A family history is also helpful; in particular, nodular sclerosis Hodgkin lymphoma (NSHL) has a strong genetic component and has often previously been diagnosed in the family


Physical Examination

Physical examination findings in Hodgkin lymphoma include the following:

  • Palpable, painless lymphadenopathy can be seen in the cervical area (neck, 60-80%), axilla (armpit, 6-20%), and, less commonly, in the inguinal area (groin, 6-20%)

  • Involvement of the Waldeyer ring (back of the throat, including the tonsils) or occipital (lower rear of the head) or epitrochlear (inside the upper arm near the elbow) areas is infrequently observed

  • Splenomegaly and/or hepatomegaly may be present

  • Superior vena cava syndrome may develop in patients with massive mediastinal lymphadenopathy

  • Central nervous system (CNS) symptoms or signs may be due to paraneoplastic syndromes, including cerebellar degeneration, neuropathy, Guillain-Barre syndrome, or multifocal leukoencephalopathy