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Hodgkin Lymphoma





The first investigation is always a complete history and physical.

Laboratory studies show non-specific abnormalities.


Work-up for Hodgkin Lymphoma:


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



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


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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