Hodgkin Lymphoma
A B-cell lymphoma with orderly, contiguous nodal spread (more predictable than NHL), classically cervical/mediastinal. Extranodal disease is less common and usually late.
Summary
HL = “nodal first, stepwise spread” + bulky mediastinum is a classic exam set-up.
Trivia
- Bimodal age distribution (young adults and older adults); male predominance in some subtypes.
- “B symptoms”: fever, night sweats, weight loss (prognostic/staging relevance). → generally associated with higher tumour burden/more advanced biology and a worse prognosis
- Characteristic "Reed-Sternberg cell" in histopathology.
Imaging features
CT
- Lymphadenopathy: often bulky, homogeneous, can be conglomerate.
- Typical distribution:
- Cervical/supraclavicular + mediastinal (very common).
- Then para-aortic/iliac with progression (contiguous pattern).
- Splenic involvement can occur; liver less common early.
- Necrosis/cavitation is not typical untreated → consider infection or aggressive NHL if prominent.
FDG PET-CT
- Most HL is strongly FDG-avid → preferred for staging and response assessment.
- Residual mass after treatment is common (fibrosis) → PET helps distinguish active vs scar.
MRI
- Problem-solving for marrow/CNS or when reducing radiation matters (esp. younger patients).
Differentials
- TB/sarcoid/reactive nodes: distribution + clinical + necrosis/calcification patterns may help.
- NHL: more often non-contiguous spread, extranodal dominant disease, necrosis in high-grade.
- Post-therapy: don’t call “residual mass = recurrence” without metabolic/serial correlation.
